Surface-optimized free flaps for complex facial defects after skin cancer

Area of Science:

• Plastic Surgery
• Dermatology
• Oncology

Background:

• Advanced non-melanocytic skin cancer (NMSC) of the face leads to significant tissue loss.
• Remote free flaps are standard for reconstruction but often result in aesthetic mismatches.
• Disadvantages include color and texture disparity, and flap bulkiness.

Purpose of the Study:

• To evaluate the efficacy of secondary correction of free flap facial reconstructions.
• To assess the improvement in aesthetic outcomes using non-cultured autologous epidermal cell (NCAEC) suspension.
• To address color and texture mismatches in facial defect reconstruction.

Main Methods:

• Four patients with facial NMSC defects underwent reconstruction with remote free flaps.
• A split-thickness skin graft (STSG) was used to create a non-cultured autologous epidermal cell (NCAEC) suspension.
• NCAEC suspension was applied to de-epithelialized flap surfaces, with debulking performed.

Main Results:

• All free flaps survived the follow-up period (11-21 months).
• Significant improvements in flap color and texture were observed post-NCAEC application.
• One case experienced delayed re-epithelialization; no STSG donor-site issues arose.

Conclusions:

• Free flap reconstruction for facial NMSC can lead to color and texture mismatches.
• Secondary de-epithelialization and NCAEC application significantly enhance aesthetic results.
• This technique offers an effective solution for improving the appearance of reconstructed facial defects.