FTSG Donor Selection — SCE Dermatology MCQ

Correct answer: D — Preauricular skin provides the best colour, texture, and thickness match for facial reconstruction; the donor site can be closed primarily and hidden in the preauricular crease

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · A = shown as D · B = shown as E

A is correct because preauricular skin provides the best colour, texture, and thickness match for facial reconstruction, and the donor site can be closed primarily and hidden in the preauricular crease. The preauricular region is thin, relatively hairless, and has similar sebaceous quality and pigmentation to facial skin, so a graft harvested there blends seamlessly rather than producing a visible patch effect. Because the skin here is loose with good local laxity, the donor defect can usually be closed directly, giving a fine scar that falls into the natural preauricular fold. This combination of an ideal aesthetic match plus a concealable donor scar is why preauricular skin is the standard first choice for grafting nasal, periorbital, and cheek defects. Why the other options are wrong: B, easiest to harvest: harvest technique is similar across donor sites; the region actually requires careful dissection near the temporal branch of the facial nerve and superficial temporal vessels. C, provides the largest graft: preauricular skin is a small donor area limited by local laxity, so it cannot supply large grafts; supraclavicular or postauricular skin offers greater surface area. D, least nerve supply: nerve density of donor skin is irrelevant since the graft is denervated and revascularises via the recipient bed; sensory recovery depends on the recipient site, not donor innervation. E, heals fastest: healing rate depends on graft thickness and recipient bed vascularity, not on donor location; a full-thickness graft from preauricular skin does not heal faster than from other sites. Key point: preauricular skin is chosen for facial FTSG for its unmatched aesthetic match with a scar hidden in the preauricular crease, not because it is easiest to harvest, largest, least innervated, or fastest healing.

Reference: PubMed: Pre-auricular full-thickness skin grafts, describing preauricular donor skin as providing valuable colour and texture match for medial canthal-nose, eyelid-cheek facial reconstruction. https://pubmed.ncbi.nlm.nih.gov/346123/