Usefulness of Nasal Splints (Aquaplast(R)) for Securing Full Thickness Skin Graft (FTSG) / 대한피부과학회지

BACKGROUND: For securing FTSG, bolus tie-over dressing is a universally accepted method, but it has some definite disadvantages. For example, bulky dressing inhibits the drainage from graft bed and can lead to maceration by occlusion. Time and effort is necessary to secure dressing and the help of an assistant is also mandatory to tie the suture much easier. OBJECTIVES: In an attempt to find a better dressing material, we evaluated the usefulness of thermoplastic nasal splints (Aquaplast(R)) for securing graft in FTSG reconstruction. METHODS: Thirteen patients with surgical defects following tumor excision from the nose(9 patients), forehead(1), lip(1), hand(1), shin(1) ranging from 12mm to 40mm in the largest diameter were reconstructed with a FTSG. For securing FTSG, a heat-moldable nasal splint was heated, contoured in place over sutured graft on recipient area with/without suture of the splint with skin. RESULTS: All of the 13 FTSG secured with nasal splints showed a good take with a satisfactory cosmetic results. Except hypertrophic scars in 4 patients, which were not significant and improved with several times intralesional injection of triamcinolone, there were no other complications. CONCLUSION: We have found a heat-moldable nasal splint to be useful material to secure FTSG, especially for the complex contoured area such as nose or ear. This technique saves time and effort and there is no need of an assistant.

Management of Hair Line Using Skin Graft after Tissue Expansion for the Auricular Reconstruction of Microtia

Reconstructing the ear with autogenous rib cartilage is one of the most preferred methods for microtic ear reconstruction. Sometimes, when using this method, the skin envelope size is not large enough for the cartilage framework. With tissue expansion, a more adequately sized hairless skin envelope can be developed. Usually we recommend that canaloplasty be delayed after external ear reconstruction. But when the external ear canal has been reconstructed before external ear reconstruction, the remaining hairless skin for an envelope is so deficient that even though using tissue expansion, it is nearly impossible to develop well-qualified hairless skin envelope. From January, 1996 to December, 1998, we reconstructed auricles using tissue expansion, followed by excision of hair-bearing skin and grafting of full-thickness skin in five microtic patients whose external ear canals had been reconstructed before external ear reconstruction. The skin donor area was the contralateral postauricular area. Two to three weeks after the skin graft, autogenous cartilage grafts followed. No graft was lost. Color and texture was well matched, and the hair-bearing tissue portions were almost completely removed. Our method has several advantages: 1) it uses local tissue maximally; 2) it leaves the capsule intact, which can improve flap circulation; 3) it may thin the flap as much as it can be, which can reveal well defined cartilage framework; 4) it allows easy removal of hair-bearing tissue portions; 5) it provides a well-vascularized bed for graft survival and preserves the temporoparietal fascia, which can be used for secondary reconstruction if necessary; 6) Tissue expansion can reduce the amount of hair-bearing portion which should be removed.