# A Single Surgeon’s Long-Term Experience With Full-Thickness Skin Grafts for Nasal Defect Reconstruction

## TL;DR

This paper presents a surgeon's long-term experience using forehead skin grafts for nasal reconstruction, showing good cosmetic results and fewer complications.

## Contribution

The study introduces the use of forehead widow’s peak skin as a reliable alternative for nasal reconstruction.

## Key findings

- Forehead FTSGs provided good color, thickness, and texture matching for nasal defects.
- The procedure avoided multiple surgeries and donor site morbidity associated with traditional methods.
- Twenty patients showed favorable outcomes with no major complications reported.

## Abstract

Nasal reconstruction is a constantly evolving area of plastic surgery. Many nasal defects are managed with staged local or regional flaps, which often impart significant donor site morbidity and may place psychosocial stress on patients. Full-thickness skin grafts (FTSGs) are a viable option for reconstruction. When FTSGs are used, the skin is typically taken from behind or in front of the ear, though this skin does not always match the nasal skin well. This study examines the use of FTSGs taken from the forehead, specifically from the widow’s peak area, to reconstruct nasal defects.

This is a retrospective study of nasal reconstructions performed by one surgeon from 2014 to 2019. After receiving IRB approval, patient charts were reviewed. Eligible patients had shallow nasal defects (skin and subcutaneous tissue only) with good blood supply in the wound bed. All FTSGs were taken from the widow’s peak area of the forehead. Grafts were thinned, placed into the defect, and secured with sutures and a bolster dressing for one week. Donor sites were closed directly if small or repaired with Yin Yang flaps if larger. Patients were followed until the site was fully healed, and outcomes focused on graft survival, cosmetic appearance, and complications.

Twenty patients met the criteria for the study; 60% were male with an average age of 74. Most (65%) had basal cell carcinoma, and the nasal tip was the most common site repaired (12 cases). The average defect size was 1.69 cm (range 0.5-4.5 cm). Cosmetic results were generally favorable, with good color, thickness, and texture matching.

This study shows that FTSGs from the forehead’s widow’s peak offer a reliable and cosmetically favorable option for nasal reconstruction, especially for lower third defects of the nose. Compared to traditional flaps or ear skin grafts, forehead FTSGs provide better skin thickness and contour match and avoid the need for multiple surgeries. This makes them an appealing option for patients who want a single-stage procedure with a quick recovery.