Aesthetic improvements of skin grafts in nasal tip reconstruction

Defect closure on the nasal tip subunit still remains challenging. Full-thickness skin transplantation still is used despite its poor outcome in terms of the nasal tip contour caused by lack of dermal tissue. To avoid subsidence deformities associated with nasal tip reconstruction with skin transplants, this study analyzed methods using combined epidermal and dermal replacement. For 30 consecutive patients with a nasal tip defect, a retrospective comparison was made between conventional full-thickness skin transplantation, retroauricular perichondrodermal composite grafts, and skin transplantation supplemented with the collagen-elastin matrix, Matriderm, used as a dermal substitute (n = 10 per study group).The postoperative results were evaluated in a randomized and blind manner by external facial surgeons using the Manchester Scar Scale. The findings showed a marked improvement in nasal tip contour with combined epidermal/dermal replacement without any deterioration in other graft qualities, justifying the additional effort involved in this procedure. Two patients developed fistulae after Matriderm-aided skin transplantation. Therefore, the authors do not consider this a suitable method for nasal tip reconstruction.