The use of skin grafts for nasal lining

The satisfactory replacement of missing nasal lining often determines the aesthetic and functional result of a nasal reconstruction. Although full-thickness skin grafts have been employed for lining in the prefabricated forehead flap technique, the results are unpredictable because they remain largely unsupported and subject to contraction. Advances in the understanding of the vasculature of the forehead flap, the use of primary and delayed cartilage grafts, and the appropriate use of operative staging permit full-thickness skin grafts to be combined with a forehead flap at the time of transfer, with little risk of loss. The technique is especially useful in the elderly or debilitated patient when a shortened operative time and less intranasal manipulation is appropriate, or when previous injury or rhinoplasty has interfered with septal blood supply, making the use of intranasal lining flaps unreliable.