This retrospective, single-center cohort study was conducted at the Department of Plastic and Breast Surgery, Aalborg University Hospital, Denmark, in accordance with Danish regulations on the protection of patient data and the principles of the Declaration of Helsinki. The study was approved by hospital management as a quality-improvement project, which waived the requirement for ethics-committee approval. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cohort studies.13 We included patients who underwent surgical resection of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) located on the auricle between January 1, 2022, and December 31, 2024. Data were collected between February 1, 2025, and April 30, 2025. Postoperative complications were assessed over a one-year postoperative period by review of patient medical records.

All consecutive adult patients reconstructed with either an STSG or an FTSG following resection of auricular NMSC during the study period were eligible for inclusion. A total of 141 patients met these criteria and were included. Patients reconstructed by techniques other than skin grafting, such as primary closure, local flaps, or wedge excision, were outside the scope of this study and were not included.

Clinical data were extracted from the electronic patient record system and entered into a predefined REDCap database. The dataset comprised patient demographics (age, sex, smoking status, and anticoagulant or antiplatelet use), tumor characteristics (histological diagnosis, size, and anatomical location on the auricle), surgical variables (graft type, donor site, and graft size), and postoperative outcomes. Standardized definitions were applied to ensure consistency across reviewers.

The primary outcome was graft take, expressed as the percentage of the graft surface area that healed, which was assessed by specially trained wound nurses using a standardized method established in a prior prospective study.14 Secondary outcomes included infection, hematoma, total necrosis, and donor-site complications. Infection was defined as a clinical wound infection requiring antibiotic treatment; hematoma as a postoperative collection of blood at the graft site; and total necrosis as complete (100%) graft loss.

Continuous variables are presented as mean (standard deviation) and compared using the Welch two-sample t-test. Categorical variables are presented as counts (percentages) and compared using the Pearson chi-squared test (with continuity correction for 2×2 tables), with the Fisher’s exact test applied when expected cell counts were small. Graft take is reported as the group mean with 95% confidence interval (CI), and the between-group difference is reported as a mean difference with 95% CI. Missing data were handled by complete-case analysis, and the number of observations contributing to each analysis is reported. To protect patient confidentiality, groups comprising five or fewer patients are reported as “≤5”. All tests were two-sided, and a P value below .05 was considered statistically significant. Analyses were performed using R statistical software (version 2026.01.2+418).

Tumor excision was performed according to standard oncologic principles. Reconstruction with either an STSG or an FTSG was undertaken on the basis of defect characteristics, patient co-morbidities and wishes as well as the surgeon's preference. FTSGs were harvested with a scalpel, defatted, and sutured into place; the preauricular region, clavicular area, and upper arm were the most common donor sites. STSGs were harvested from the thigh using an electric dermatome, trimmed to fit the defect, and applied to the recipient site. In both techniques, fixation was achieved with monofilament, non-absorbable sutures, followed by a compressive (tie-over) dressing to ensure adequate contact between the graft and the recipient bed. Dressings were typically removed after approximately one week in our plastic surgery wound clinic.

A total of 141 patients were included, of whom 58 underwent reconstruction with an STSG and 83 with an FTSG. The two groups were comparable with respect to demographic characteristics and most baseline clinical variables (Table 1). Patients were predominantly male (approximately 80% in both groups) and elderly (mean age 78.1 years in the STSG group and 74.7 years in the FTSG group; P=.06).

Values are mean (SD) or n (%). STSG, split-thickness skin graft; FTSG, full-thickness skin graft. P values from the Welch two-sample t-test (continuous variables) and the Pearson chi-squared test (categorical variables). Smoking counts of five or fewer are reported as “≤5” to protect patient confidentiality.

BCC was the most common diagnosis (74% in the STSG group and 77% in the FTSG group) (Table 2). The distribution of graft type differed significantly by tumor location (P<.001).

STSG accounted for a higher proportion of conchal (cavum conchae) defects (19% vs 6%) and posterior auricular defects (28% vs 13%), whereas FTSG was used more frequently for helical defects (46% vs 17%) (Table 2).

Values are n (%) or mean (SD). BCC, basal cell carcinoma; SCC, squamous cell carcinoma. P values from the Pearson chi-squared test (categorical variables) and the Welch two-sample t-test (continuous variables).

STSG showed higher graft take than FTSG. Mean graft take (the percentage of the graft surface area that healed) was 90.0% (95% CI 83.1–96.9) in the STSG group and 78.9% (95% CI 70.9–87.0) in the FTSG group, corresponding to a mean difference of 11.0% (95% CI 0.6–21.5; P=.04) (Table 4).

Postoperative complication rates were low overall and did not differ significantly between groups (Table 4). Infection occurred in 10% of patients in the STSG group and in 16% of those in the FTSG group (P=.51). Rates of hematoma, total necrosis, and donor-site complications were similarly low, with no statistically significant differences between groups.

Values are n (%). STSG, split-thickness skin graft; FTSG, full-thickness skin graft. P values from the Pearson chi-squared test. The “Other” donor-site category includes the upper arm and other minor sites.

Graft take is reported as mean (95% CI); other continuous values are mean (SD); categorical values are n (%) unless otherwise indicated. Hematoma combines minor and major events. Counts of five or fewer patients are reported as “≤5” (without a percentage) to protect patient confidentiality. P values from the Welch two-sample t-test (continuous variables) and the Pearson chi-squared test (categorical variables).

Although FTSGs are often favored for their superior aesthetic outcomes, including improved contour and reduced contraction, which may be less relevant on the auricle,11 these outcomes were not evaluated in the present study. Because graft type was selected at the discretion of the operating surgeon and according to patient preference, allocation was non-random; the two groups therefore differed systematically in tumor size and anatomical location (Table 2), raising the possibility of confounding by indication that could not be addressed by statistical adjustment in this descriptive analysis. The study is further limited by its retrospective, single-center design and by the relatively small number of complication events, which limits statistical power and increases the risk of type II error. Long-term recurrence rates and patient-reported aesthetic outcomes were not assessed.