Outcome Assessment of Local Flap versus Skin Graft in Small Facial Defects Reconstruction

Background: Facial reconstruction after trauma or lesion excision requires techniques that restore both function and aesthetics. Local flaps and skin grafts are commonly employed for small facial defects, yet the optimal choice remains debated. This study aimed to compare the functional and aesthetic outcomes of local flap reconstruction versus split-thickness skin grafting in small facial defects.

Material and Methods: A prospective comparative study was conducted on 78 patients presenting with facial defects measuring up to 5 cm in diameter. Patients were randomly assigned to two groups: Group A (n = 39) underwent local flap reconstruction (advancement, rotation, or transposition flaps), and Group B (n = 39) received split-thickness skin grafts. Postoperative outcomes were evaluated at 1 week, 1 month, and 3 months, assessing graft/flap survival, aesthetic and functional results, and complications. Statistical analysis was performed using SPSS v26.0, with p < 0.05 considered significant.

Results: Baseline demographic and defect characteristics were comparable between groups (p > 0.05). The mean operative time was longer for flaps (76.4 ± 12.3 min) than grafts (68.2 ± 11.7 min; p = 0.004). Complete take was higher in the flap group (94.9%) versus graft group (84.6%; p = 0.046). At three months, the mean aesthetic score was significantly better in the flap group (4.3 ± 0.6) compared to grafts (3.5 ± 0.7; p < 0.001). Satisfactory color match, texture conformity, and contour restoration were more frequent with flaps (p < 0.05). Contracture (10.3%) and pigment mismatch (25.6%) occurred only or predominantly in graft cases (p < 0.05). The mean hospital stay was shorter in the flap group (3.4 ± 1.2 days) than in the graft group (4.1 ± 1.6 days; p = 0.049).

Conclusion: Both techniques achieved acceptable coverage; however, local flap reconstruction yielded superior aesthetic and functional results with fewer postoperative complications. Skin grafting remains suitable for selected cases but carries a higher risk of pigmentary and contracture-related sequelae.