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CC BY 4.0 · Indian J Plast Surg 2025; 58(04): 259-268
DOI: 10.1055/s-0044-1801836
Original Article

Descending the Reconstruction Ladder: Single-Stage Full-Thickness Skin Grafting for Wide Nasal Skin Malignant Defects

Francisco J. Villegas-Alzate 
1   Plastic Surgery Unit, Clínica San Francisco, Tuluá, Valle, Colombia
2   Department of Plastic Surgery, Universidad del Valle, Cali, Colombia
,
Ana G. Cabezas-Charry 
2   Department of Plastic Surgery, Universidad del Valle, Cali, Colombia
,
Víctor A. Cardona 
3   Department of Statistics, Universidad San Martin, Cali, Colombia
,
Juan F. Ayala 
2   Department of Plastic Surgery, Universidad del Valle, Cali, Colombia
,
José D. Villegas 
4   Department of Plastic Surgery,Universidad de Antioquia, Medellín, Colombia
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Abstract

Background

Complex nasal reconstructions traditionally use staged flaps, with skin grafts reserved for smaller defects.

Objective

This study evaluates single-stage full-thickness skin grafting (FTSG) for wide nasal defects postcancer resection.

Materials and Methods

A retrospective analysis included 52 patients with nasal malignant lesions limited to the skin, reconstructed in a single stage immediately after cancer resections. Defects were intentionally over- or downsized to align with the esthetic unit concept. Templates of the defects were used to harvest FTSG. All donor areas were closed primarily. The graft was carefully sutured to fit the defect, and bolsters were applied for 5 to 12 days. Postoperative taping was used for 4 months. Postoperative photographs were assessed by 92 independent raters using a visual analog scale evaluating five parameters: skin color matching, surface regularity, symmetry, perimetral contours, and overall nasal appearance. Results and complications were analyzed for statistical associations.

Results

On average, 3.5 of 9 nasal units per patient were reconstructed, covering 55.5% of the nasal surface. Local anesthesia was used in 90.4% of cases. Periclavicular and retroauricular donor sites were used in 61.5 and 34.6% of cases, respectively. Evaluators rated the outcomes at an average of 7.1/10 (range 5.1–8.8). The complication rate was 15.4%. No significant correlations were found between the outcomes and the analyzed factors.

Conclusion

FTSG effectively reconstructs wide nasal defects in a single stage, predominantly under local anesthesia, with satisfactory outcomes. This approach signifies a descent down the reconstruction ladder, shifting from complex, flap-staged methods to a single-stage solution.

Keywords

nose - skin - questionnaires - patient-reported outcome

Authors' Contributions

F.J.V.-A. contributed to conceptualization, methodology, investigation, and writing the original draft. A.G.C.-C. and J.F.A. contributed to writing the original draft. V.A.C. conducted the formal analysis. J.D.V. investigated the study and contributed to writing the original draft.


Ethical Approval

The study protocol was reviewed and approved by the IRB of Clínica San Francisco, Tuluá, ensuring adherence to ethical standards and patient safety.




Publikationsverlauf

Artikel online veröffentlicht:
24. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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