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

Abstract

Background: A full-thickness skin graft is a commonly used method for repairing smaller nasal defects. Secondary healing is a simple alternative with many advantages, although it is associated with a long duration of healing. The aim was to compare the short- and long-term results of skin graft transplantation or secondary healing for small nasal wound defects after tumor excision. Methods: Adult patients admitted for nasal tumor resection were randomized to treatment with either full-thickness skin graft or secondary healing intent. Healing and complications were assessed at 1 and 4 weeks. Scar quality was assessed with the patient and observer scar assessment scale (POSAS) 6 months postoperatively. Results: Twenty-six patients were included. Three patients healed within a week in the skin graft group, whereas none had healed after a week in the secondary healing group (SHG). Healing time (median [interquartile range]) was 35.0 (28.0–41.0) days and 28.0 (12.0–48.0) days in the SHG and skin graft group, respectively (P = 0.47). Patient-POSAS scores reported better scores in the SHG for all 6 items (pain, itching, color, stiffness, thickness, and irregularity), although not significantly. Observer-POSAS reported better scores in the SHG for vascularity, pigmentation, thickness, and relief (P = 0.003, 0.007, 0.002, and 0.01, respectively). Conclusions: Healing time did not differ between the 2 groups. The cosmetic outcome showed promising results in the SHG, suggesting that allowing secondary healing for superficial, smaller nasal defects after tumor surgery may be beneficial. However, the strength of this conclusion is hampered by the small study group.