Surgical pearl: clavicular grafts are "superior" to supraclavicular grafts

Usefulness of full-thickness skin grafting from the infraclavicular area for facial reconstruction

Background

Full-thickness skin grafts (FTSGs) have been widely used after facial skin cancer resection, for correcting defects that are too wide to be reconstructed using a local flap or if structural deformation is expected. The preauricular, posterior auricular, supraclavicular, conchal bowl, nasolabial fold, and upper eyelid skin areas are known as the main donor sites for facial FTSG. Herein, we aimed to describe the effectiveness of using infraclavicular skin as the donor site for specific cases.

Methods

We performed FTSG using the infraclavicular skin as the donor site in older Asian adults following skin cancer resection. Outcomes were observed for > 6 months postoperatively. The Manchester Scar Scale was used for an objective evaluation of satisfaction following surgery and scarring.

Results

We analyzed the data of 17 patients. During follow-up, the donor and recipient sites of all patients healed without complications. Upon evaluation, the average Manchester Scar Scale scores for the recipient and donor sites were 7.4 points and 5.7 points, respectively.

Conclusion

In general, conventional donor sites, such as the preauricular, posterior auricular, and supraclavicular sites, are widely used for facial FTSG because they achieve good cosmetic results. However, the infraclavicular skin may be a useful donor for facial FTSG in cases where the duration of time spent under anesthesia must be minimized due to a patient’s advanced age or underlying health conditions, or when the recipient site is relatively thick area, such as the nose, forehead, or cheek.

Article Commentary: Optimizing Aesthetic Results in Skin Grafting

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.

Current techniques in skin grafting

A thorough knowledge of the techniques used in skin grafting is a necessity for successful soft-tissue reconstruction. Careful attention to detail and planning should ensure an excellent outcome. Current research in the fields of tissue engineering and skin substitutes continues to evolve with the ultimate goal being tissue-engineered skin that matches the quality of the autologous skin graft.

Burow's grafts in the facial region

BACKGROUND

Full-thickness skin grafts are an important tissue source for reconstructive surgery. Burow's grafts are full-thickness skin grafts that use adjacent lax skin as the donor site. This technique has also been referred to as island grafts, dog-ear grafts or adjacent-tissue skin grafts.

OBJECTIVE

The objective was to describe the technique of Burow's grafts for reconstruction of facial defects taking account of its benefits and limitations.

METHODS

The operative technique is simple: after a circular excision of the cutaneous lesion, we enlarged the excision line (towards one or both sides of the defect) following the relaxed tension lines. We created a secondary triangular defect by excising skin that is then used for the graft (as donor site). After adequate undermining, we proceeded to direct linear closure of this secondary defect. Finally, the graft was placed and sutured in the remaining defect.

RESULTS

The proximity of the donor site provides an excellent tissue match because colour, hair density, texture, sebaceous features and thickness are similar to the recipient site. A good cosmetic result is therefore ensured.

CONCLUSION

Burow's grafts can be a good choice for reconstruction of extensive facial surgical defects because of aesthetic results. In addition, it is a simple technique that can be performed in one sole surgical act, with local anaesthesia and without changing the operative site.

Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts

BACKGROUND

Skin grafting has evolved in the past centuries to encompass numerous well-established reconstruction techniques that are uniquely able to restore structure, function, and cosmesis to a variety of surgical wounds.

OBJECTIVE

To provide a detailed overview of the general principles of skin grafting geared for the dermatologist and the dermatologic surgeon.

METHODS

Comprehensive review of the literature.

RESULTS

A summary of the different applications and techniques of full- and split-thickness skin grafts, free cartilage grafts, and composite grafts is presented. Indications, advantages, disadvantages, techniques, and complications are discussed in depth.

CONCLUSION

Skin grafting is a dynamic and versatile method of cutaneous reconstruction that can be accomplished successfully with a thorough understanding of the principles and techniques of grafting.

Forehead donor site full-thickness skin graft

BACKGROUND

Full-thickness skin grafts (FTSGs) are useful for reconstructing nasal defects. Traditional reported donor sites include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, melolabial fold, and upper eyelid skin. Selection of the "best" donor site is based on the "best" tissue match and ability to camouflage the donor scar.

OBJECTIVE

The purpose was to report our experience with FTSGs harvested from the forehead for reconstruction of nasal defects following Mohs' surgery.

METHODS

A retrospective query of the Mohs' surgery database was performed to identify nasal defects repaired with a FTSG harvested from the forehead skin. The research record contained the patient age and gender, defect size, and cosmetic and functional outcomes interpreted by the patient and surgeon.

RESULTS

FTSGs from forehead skin were used to repair the nasal defects in three patients. The functional and cosmetic outcome of all three cases was deemed excellent by the patient and surgeon. Donor site scars were well concealed within preexisting rhytids.

CONCLUSION

FTSGs harvested from the forehead, although limited in practical utility, may offer an optimal FTSG match for limited select defects while also providing an easily camouflaged donor site scar within a forehead rhytid.

Skin grafting

Knowledge of the indications, techniques, donor site considerations, and complications of all types of skin grafting is invaluable for the dermatologic surgeon who performs soft tissue reconstruction on a regular basis. With proper defect assessment, reconstructive planning, and attention to detail pre-, intra-, and postoperatively, optimal cosmetic and functional results using skin grafting techniques can be achieved.