Abstract
Skin grafts are commonly used for reconstruction of defects following excision of
facial skin cancers. Tie-over bolster dressings are routinely placed to secure these
grafts, but are they necessary for healing or graft success? A total of 96 patients was treated from 2013-2019 who underwent full thickness skin
graft (FTSG) reconstruction following facial skin cancer excision were retrospectively
analysed. All patients were treated by one consultant with non-fenestrated FTSG’s
placed on defects varying from 10 to 55mm in maximum diameter. Grafts were sutured
circumferentially with a continuous resorbable suture. Tie-over bolster dressings
were not used, and the recipient site was dressed with MepitelTM and SteristripsTM. Primary defect sites where we used this technique included the pinna, the nose and
face, and less commonly, the scalp. Graft harvest sites included the neck, pre-auricular,
and submental regions. Complete graft take was noted in 94/96 patients. Partial graft failure was observed
in two patients, one who healed and had successful late scar revision surgery and
one who was managed conservatively and healed well. Two further patients with complete
graft healing later underwent minimal revisional contour surgery with satisfactory
results. This retrospective study has shown FTSG success in cutaneous defects of the head and
neck to be excellent without the use of tie-over bolsters. This has significant benefits
of saving operative time, reducing cost, and sparing the patient both unnecessary
intraoperative steps, and the inconvenience of a bolster with its often-painful removal.
We recommend that the use of tie-over bolsters in the management of most FTSG reconstructed
head and neck cutaneous defects be considered an unnecessary step. We believe there
are no adverse effects of our described simple technique, and that there are significant
benefits to the patient.
Keywords
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Article Info
Publication History
Published online: March 11, 2022
Accepted:
March 8,
2022
Received in revised form:
January 7,
2022
Received:
November 26,
2020
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
