Comment on “Full-Thickness Skin Grafts and Quilting Sutures for Reconstruction of Internal Nasal Lining”

Skin graft “take” requires that it lie immobilized and in contact with a well-vascularized recipient bed. The paper by Gostian et al outlines their experience with a simple method to improve the vascularization of skin grafts when used to line full-thickness nasal defects.

Neck or groin full-thickness skin grafts (described as both “free skin flaps” and “free skin grafts”) were sutured to the margins of the lining defect in 16 patients. A full-thickness nonexpanded forehead flap was transferred to replace missing overlying external skin. Multiple percutaneous full-thickness quilting sutures were passed through the external surface of the forehead flap to fix the skin graft to the raw surface of the forehead flap. No support was placed initially. Later, during an intermediate operation, delayed primary grafts were placed to support the skin graft. At a third stage, the pedicle was divided. The skin graft take was excellent and the forehead flap suffered no serious sequelae. Complications were minimal and results were good.

Unfortunately, the dimensions of the external skin and lining defects, the size of the lining skin grafts, and the duration of quilting suture placement are not specified. They emphasize that skin graft lining must be “supported” but do not describe the design or position of the cartilage grafts. They do not address when, how, or if associated cartilage injuries were repaired in the neighboring areas of the external wound where the lining remained intact.

Although the case descriptions are confusing, the technique seems to have been applied to repair small to moderate full-thickness defects of part or all of the ala and sidewall, as well as central defects of the tip and septal angle when significant residual central septal support remained intact.

So how should we incorporate lining skin grafts and percutaneous suture fixation into the repair of full-thickness nasal defects?[1]

• References

• 1 Menick FJ. Aesthetic Nasal Reconstruction: Principles and Practice. Phoenix, AZ: Aesthetic Nasal Reconstruction Press; 2018