Page 25 - Read Online

Page 6 of 11 Hicks et al. Plast Aesthet Res 2022;9:2 https://dx.doi.org/10.20517/2347-9264.2021.65

Figure 3. Common sites for harvesting full-thickness skin grafts for facial reconstruction. (Reused Figure 15-13 in Local Flaps in Facial
[1]
Reconstruction, 3rd ed., with permission from Elsevier) .

vascularization process mimics that of skin grafts, although host vessels cannot penetrate cartilage .
[6]
Survival of composite grafts is contingent upon adequate revascularization. Careful surgical planning and
meticulous technique help in this pursuit. Additionally, the following patient factors are recommended to
optimize patient selection and survival of grafts: patient age < 65 years, no tobacco use, and no systemic
disease processes that would compromise revascularization .
[6]
Uses
Composite grafts are typically used to repair small defects that require not only good color and texture
match but also a degree of contouring and support. As mentioned above, typically, these grafts are kept to
1 cm or smaller in all dimensions. However, larger grafts may be used if they are being placed in a
particularly vascular wound bed; constructing a hinge flap of vascular tissue is a technique that improves the
[7]
exposure of graft to vascularized tissue . For skin-cartilage composite grafts, harvesting a higher ratio of
skin to cartilage results in graft behavior similar to that of a full-thickness skin graft, increasing the viability
[6]
and enabling the use of a larger graft . Composite grafts are frequently employed in repairing small, full- or
partial-thickness defects of the eyelid, auricle, and nasal ala, columella, rim, and sill.

Technique
Harvesting and utilizing composite grafts is not technically difficult, but thoughtful planning is essential to
the success of these repairs. An important consideration in the planning phase is that composite grafts tend
to contract significantly, which can compromise the aesthetic and functional result if not accounted for. As
such, these grafts may be intentionally oversized to compensate for contraction.