A Comparison of Treatment With Skin Graft or Secondary Healing for Nasal Wound Defects After Tumor Excision

PRS Global Open, March 2025

Key take aways:

• Secondary healing of small (<3x3 cm) wounds on the tip or ala yields superior cosmetic outcomes compared to FTSG, although time to heal is slightly longer

Background

• The treatment strategies for small nasal wound defects post-tumor excision often involve complex decisions regarding cosmetic outcomes and healing duration.

  
  

Objective

• This study's primary aim was to evaluate the short- and long-term healing outcomes and cosmetic results of using FTSG versus secondary healing in patients with nasal defects post-tumor excision.

Methods

• RCT at Linköping University Hospital

  • Inclusion:

    • 18+ yo

    • Wound measuring 3x3 cm or smaller on the tip or alae

    • Max depth: intact perichondrium (i.e. graftable)

• Participants randomized to FTSG or secondary healing

  • Both groups were dressed with PolyMem (hydrophilic polyurethane foam) dressings

• Primary outcomes included hand scar quality as assessed by Patient and Observer Scar Assessment Scale (POSAS) :

  • POSAS performed in short term (1 and 4 weeks) and long term (6 mo)

    
    

Results

• A total of 30 patients were enrolled, and after exclusions for re-excision or withdrawal, 26 were analyzed.

• Median age of participants was 74.5 years, 50% were male.

• Healing times presented as median (IQR) were 35.0 days in the secondary healing group (SH) versus 28.0 days in the skin graft group (FTSG), with no statistically significant difference (P = 0.47).

• At the 6-month follow-up, the SH group demonstrated superior scores in observer-assessed key parameters: vascularity (P = 0.003), pigmentation (P = 0.007), thickness (P = 0.002), and relief (P = 0.01).

• Overall, patient-reported outcomes showed significant satisfaction in the SH group regarding scar aesthetics

  
  

Conclusion

• While the healing duration was slightly longer for secondary healing, the long-term cosmetic results indicated that this approach may provide superior long-term outcomes compared to skin grafting.

  
  

Strengths and Limitations

• Strengths include the randomized controlled design and the comprehensive follow-up using validated scar assessment tools.

• Limitations include:

  • Small sample size

  • Long-term follow up limited to 6mo

  • Average age was 75 yr; do results apply to younger population?

    
    

Future Directions

• Studies need to evaluate if these results are generalizable to younger patients

• Consider hybrid approaches (i.e. Integra then FTSG)

Clinical Relevance

• The findings suggest a less invasive (and presumably less costly) approach may yield better cosmetic outcomes in elderly patients with small (3x3 cm), superficial ablative wounds of the tip or alae