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CONCLUSIONS

A working knowledge of the indications, techniques, donor site considerations, and postoperative complications of all types of skin grafts is necessary for soft tissue reconstruction. As the incidence of skin cancer continues to rise, increasing numbers of patients are likely to undergo reconstructive procedures requiring full-thickness skin and/or cartilage grafting. Lower extremity ulcers are another common problem, and splitthickness skin grafting remains an effective, reasonable treatment for such patients. With proper defect assessment, reconstructive planning, and attention to detail preoperatively, intraoperatively and postoperatively, optimal cosmetic and functional results can be achieved using the full range of grafting techniques, a thorough understanding of which is therefore invaluable for all physicians performing reconstructive surgery.

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6. Walden JL, Garcia H, Hawkins H, et al. Both dermal matrix free skin graft. Ann Plast Surg. 1982;9:242–245.2. Ratner D. Skin grafting. Semin Cutan Med Surg.

7. Kaufman AJ. Adjacent-tissue skin grafts for recon- and epidermis contribute to an inhibition of wound contraction. Ann Plast Surg. 2000;45:162–166.7. Gloster Jr. HM. The use of full-thickness skin grafts to

2003;22:295–305.3. Adams DC, Ramsey ML. Grafts in dermatologic surgery:

struction. Dermatol Surg. 2004;30:1349–1353.12. Wang Q, Cai M, Wu YL, Zhang GC. Mathematical guide to minimize donor site in full-thickness skin grafting. Dermatol Surg. 2009;35:1364–1367.13. Hill TG. Contouring of donor skin in full-thickness skin repair nonperforating nasal defects. J Am Acad Dermatol. 2000;42:1041–1050.8. Rohrer TE, Dzubow LM. Conchal bowl skin grafting in review and update on full- and split-thickness grafts, free cartilage grafts and composite grafts. Dermatol Surg. 2005;31:1055–1067.4. Smahel J. The healing of skin grafts. Clin Plast Surg.

grafting. J Dermatol Surg Oncol. 1987;13:883–888.14. Larson PO, Ragi G, Mohs FE, Snow SN. Excision of exposed nasal tip reconstruction: clinical and histologic evaluation. J Am Acad Dermatol. 1995;33:476–481.9. Zitelli JA. Burow’s grafts. J Am Acad Dermatol.

1977;4:409–424.5. Goldminz D, Bennett RG. Cigarette smoking and cartilage for management of Mohs surgery defects of the ear. J Dermatol Surg Oncol. 1991;17:749–752.15. Craven NM, Telfer NR. An open study of tissue adhesive

1987;17:271–279.10. Krishnan R, Hwang L, Orengo I. Dog-ear graft technique.

flap and full-thickness graft necrosis. Arch Dermatol. 1991;127:1012–1015.

in full-thickness skin grafting. J Am Acad Dermatol. 1999;40:607–611.

Dermatol Surg. 2001;27:312–314.

Postoperative tenderness, swelling, and erythema may herald inflammatory chondritis or perichondritis, which should be treated with cool compresses and nonsteroidal anti-inflammatory drugs for several weeks or even months postoperatively.

Later complications may include graft resorption, displacement or deformation after placement, and extrusion. Surgical revision may be required if these complications occur. Auricular and nasal recipient sites are subject to trauma and are therefore at increased risk of graft displacement and resorption. Every effort should therefore be made intraoperatively to utilize grafts of sufficient thickness and stiffness to resist the forces of trauma and wound contracture, and to anchor these grafts to maximize their stability.

While autologous cartilage is considered the optimal grafting material due to its pliability, accessibility, and ease of harvesting under local anesthesia, its supply may be limited, and harvesting may entail additional morbidity. Other implantable materials for nasal reconstruction have been investigated, including porous, high-density polyethylene implants, which have been well tolerated as replacements for native cartilage in patients requiring rhinoplasty or nasal reconstruction.

Tissue engineering has been used to generate autologous cartilage implants to fill defects of the nose or outer ear. Chondrocytes can be stimulated with growth factors to increase their proliferative rate and extracellular matrix production. Such chondrocytes, when implanted in a resorbable synthetic scaffold, can thereby be induced to produce three-dimensional aggregates of cartilage. In one study, collagen lattices containing cultured chondrocytes implanted into rabbit auricular cartilage generated new cartilage within 5 weeks. In vitro engineering of human cartilage could be the ideal replacement method, without the risk of infection and with the possibility of reconstructing large defects with different configurations. In a first-in-human trial, autologous chondrocytes harvested from the nasal septum were cultured in media with autologous serum and seeded onto collagen type I and type III membranes. After 4 weeks, the resulting engineered cartilage grafts, 25 × 25 × 2 mm, were successfully implanted beneath forehead or nasolabial flaps, just as native auricular cartilage would have been, with comparable aesthetic and functional results. These and newer implantable materials should become increasingly available over time, and will undoubtedly be useful for surgeons who perform nasal reconstruction.