Abstract
Nasal reconstruction is a constantly evolving area of plastic surgery. Many nasal defects are managed with staged local or regional flaps, which often impart significant donor site morbidity and may place psychosocial stress on patients. Full-thickness skin grafts (FTSGs) are a viable option for reconstruction. When FTSGs are used, the skin is typically taken from behind or in front of the ear, though this skin does not always match the nasal skin well. This study examines the use of FTSGs taken from the forehead, specifically from the widow's peak area, to reconstruct nasal defects. This is a retrospective study of nasal reconstructions performed by one surgeon from 2014 to 2019. After receiving IRB approval, patient charts were reviewed. Eligible patients had shallow nasal defects (skin and subcutaneous tissue only) with good blood supply in the wound bed. All FTSGs were taken from the widow's peak area of the forehead. Grafts were thinned, placed into the defect, and secured with sutures and a bolster dressing for one week. Donor sites were closed directly if small or repaired with Yin Yang flaps if larger. Patients were followed until the site was fully healed, and outcomes focused on graft survival, cosmetic appearance, and complications. Twenty patients met the criteria for the study; 60% were male with an average age of 74. Most (65%) had basal cell carcinoma, and the nasal tip was the most common site repaired (12 cases). The average defect size was 1.69 cm (range 0.5-4.5 cm). Cosmetic results were generally favorable, with good color, thickness, and texture matching. This study shows that FTSGs from the forehead's widow's peak offer a reliable and cosmetically favorable option for nasal reconstruction, especially for lower third defects of the nose. Compared to traditional flaps or ear skin grafts, forehead FTSGs provide better skin thickness and contour match and avoid the need for multiple surgeries. This makes them an appealing option for patients who want a single-stage procedure with a quick recovery.