From all that I have read, it appears that flaps often produce a far superior aesthetic outcome when compared to using skin grafts. Why would a Mohs surgeon choose to use a skin graft for a small defect on the nasal sidewall when an uncomplicated flap is an option? Is it easier/quicker for the surgeon to accomplish the repair using a graft?
Answer: Flaps versus Graft Hello. This is a very interesting question. Of course, I would need to see photos, etc before making a determination. It is not unreasonable to graft the nasal sidewall, as the skin on the nasal sidewall is thin and pliable and supports skin grafting. In contrast, the skin comprising the nasal tip is much thicker and more sebaceous. Hope this makes sense. Best wishes. Good luck. Dr. Shah
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Answer: Flaps versus Graft Hello. This is a very interesting question. Of course, I would need to see photos, etc before making a determination. It is not unreasonable to graft the nasal sidewall, as the skin on the nasal sidewall is thin and pliable and supports skin grafting. In contrast, the skin comprising the nasal tip is much thicker and more sebaceous. Hope this makes sense. Best wishes. Good luck. Dr. Shah
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September 1, 2015
Answer: Mohs Surgery Graft or Flap for Repair on the Nose
This is a very good question. A flap is tissue that brings its own blood supply with it. It can be a random flap which has a more unreliable blood supply or it can have a blood vessel running in the flap called and axial flap that has a more robust blood supply and thus more reliable.
A graft is a piece of skin that is thin and taken free form the body and sewn into place on the defect. Blood supply grows into this tissue from the bed. It may be more difficult for blood supply to grow into the graft for many reason. (bad recipient site, smoking, infection, sheer forces. etc.)
One problem with small flaps on the face is swelling of the flaps called pin- cushioning. A classic example is the bilobed flap. Looks great in the books and when the flap is initially performed but the final result is often "puffy" and often requires revision.
Although I prefer flaps on the face to close Mohs defects, the nasal side wall is actually a very reasonable site for a full thickness skin graft and would likely be high on my selection list as well. A skin graft is not necessarily faster either because of donor site closure and bolster placement. (A bolster holds the graft down to the wound bed.)
I hope that you did well and that this helps answer your question.
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September 1, 2015
Answer: Mohs Surgery Graft or Flap for Repair on the Nose
This is a very good question. A flap is tissue that brings its own blood supply with it. It can be a random flap which has a more unreliable blood supply or it can have a blood vessel running in the flap called and axial flap that has a more robust blood supply and thus more reliable.
A graft is a piece of skin that is thin and taken free form the body and sewn into place on the defect. Blood supply grows into this tissue from the bed. It may be more difficult for blood supply to grow into the graft for many reason. (bad recipient site, smoking, infection, sheer forces. etc.)
One problem with small flaps on the face is swelling of the flaps called pin- cushioning. A classic example is the bilobed flap. Looks great in the books and when the flap is initially performed but the final result is often "puffy" and often requires revision.
Although I prefer flaps on the face to close Mohs defects, the nasal side wall is actually a very reasonable site for a full thickness skin graft and would likely be high on my selection list as well. A skin graft is not necessarily faster either because of donor site closure and bolster placement. (A bolster holds the graft down to the wound bed.)
I hope that you did well and that this helps answer your question.
Helpful