Should all skin grafts be low fat? Composite skin and fat grafts in facial reconstruction

Reconstruction of the nose and scalp after resection of cutaneous malignancy can be challenging, and can involve multiple stage surgery and cause secondary scarring in adjacent facial areas. The author describes his experience of a series of 100 composite full thickness skin and fat grafts in the head and neck region using the neck as the donor site. The technique was used to reconstruct the nose (n = 48) and scalp including temple and forehead (n = 46), and at 6 other sites, mainly the cheek or lower eyelid. Defects ranged in size from 11 to 36 mm and the thickness of fat varied from 1 to 5 mm. One flap failed, one patient had necrosis of roughly 30% of the graft, which did not require surgical intervention, and one patient had early defatting of a prominent graft. The author outlines the technique used and the complications, and discusses the benefits and limitations of the technique, which, he believes, has a role in carefully selected patients.