A full-thickness skin graft is a piece of skin taken completely free from another part of the body and laid into the wound left by Mohs micrographic surgery. Unlike a flap, a graft brings no blood supply of its own. It survives by taking up nourishment from the wound bed beneath it over the first few days, which is why graft aftercare is so important.
A skin graft on the nose after BCC removal is one of the most common reconstructions in Mohs surgery. Miss Rakhee Nayar, dual-trained in Mohs and plastic surgery, selects the donor site specifically to match the colour, thickness and texture of the area being repaired.
When a full-thickness graft is used
- The defect is too large to close directly but a flap would distort a nearby feature.
- The wound sits on the side or bridge of the nose, the lower eyelid, the ear or the forehead.
- It is preferable to keep the area flat and easy to monitor for any recurrence.
- The patient would rather avoid the longer, staged surgery a large flap can involve.
Where the graft comes from
Common donor sites are the skin in front of or behind the ear, the upper eyelid, the neck and the inner upper arm. These areas are chosen because the skin is a close match for facial skin and the donor site itself can be closed as a fine line hidden in a natural crease.
What the procedure involves
The graft is performed under local anaesthetic once the microscope confirms the cancer is fully removed. The graft is cut slightly larger than the defect, thinned to the right depth, laid in and stitched around its edge. A firm dressing, sometimes stitched in place as a tie-over bolster, holds the graft in close contact with the wound bed. That dressing usually stays undisturbed for five to seven days.
Nose skin graft healing stages
- Days 1 to 7. The dressing stays on and dry. The graft is taking up its blood supply. This is the most important week.
- Week 1. The dressing and stitches come off. The graft often looks purple, dusky or crusted at this stage. This is normal and not a sign of failure.
- Weeks 2 to 6. Colour shifts from purple towards pink. Some surface crust separates. The graft may sit slightly lower than the surrounding skin.
- Months 2 to 6. Colour and texture begin to blend. The edge softens.
- Months 6 to 12. Final colour settles. Grafts often remain marginally paler or flatter than the skin around them.
Scars and refinements
A graft leaves a visible patch rather than a line, so the match is never quite perfect. Where the contour or colour is not ideal at twelve months, small refinements such as dermabrasion or scar revision can improve it. A local flap is generally preferred where a closer match is achievable.
Book a consultation
To discuss Mohs surgery and reconstruction with Miss Nayar, please use the contact form or call the clinic directly.
Book a consultation
If you are facing Mohs surgery and want to understand how your wound would be repaired, this is exactly what a consultation covers. Bring your referral letter or biopsy result if you have one.