Full-thickness skin graft (FTSG) is a core reconstructive option for small to moderate nasal defects after oncologic resection. By providing full dermal thickness and adnexal structures, they offer durability, sensory recovery and good aesthetic potential. However traditional FTSGs often struggle with contour and colour match on the nose. The contoured composite graft refines the FTSG technique by emphasising optimal donor site selection, meticulous tissue handling, precise haemostasis, accurate inset and strict postoperative care. Limitations in traditional FTSGs frequently arise from habitual use of preauricular or supraclavicular donor sites and graft thinning, driven by concerns of graft survival. While colour match is usually considered, dermal thickness and sebaceous match, essential for nasal reconstruction, are often overlooked. We advocate for alternative donor sites such as the infraauricular and upper neck region, dog ear grafts, and the glabella, which provide superior match to nasal skin. Graft inset should focus on meticulous dermal opposition, supported with a traditional tie-over dressing and additional contouring aided by jelonet pledgets. We recommend maintaining the tie over for a full three weeks to optimise graft integration. The contoured composite graft offers a more reliable and aesthetically harmonious solution than traditional FTSGs, achieving outcomes that often surpass both standard grafts and local flaps. Techniques and examples demonstrated in this presentation.

Objective This project aims to develop a resorbable 3D-printed collagen venous anastomotic coupler with applicator for microvascular surgery. Introduction Venous anastomoses are a critical determinant of free flap success, with thrombosis and technical failure contributing significantly to flap loss. Current coupler devices are limited to venous couplers due to issues with material rigidity and permanent foreign body implantation. Biodegradable collagen offers a biologically integrated alternative. Method A biodegradable collagen coupler and dedicated applicator were designed and fabricated using high-resolution 3D printing. Devices were evaluated for mechanical strength, ease of deployment, luminal patency, and degradation characteristics. Bench-top microvascular models were used to assess anastomotic integrity. Results The collagen coupler demonstrated reliable deployment, maintained luminal patency, and provided sufficient tensile strength for venous anastomosis. Controlled degradation occurred without structural collapse. Handling characteristics were comparable to existing coupler systems. Conclusion This study demonstrates the feasibility of a 3D-printed collagen venous coupler as a biodegradable alternative to permanent devices. This platform may reduce long-term foreign body complications in microvascular surgery.