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Skin Color Match in Head and Neck Reconstructive Surgery
Philip Daniel Knott1, Sean A Alemi1, Mary Han1
1Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A.
The Laryngoscope
|December 14, 2021
Summary
Split-thickness skin grafts (STSG) over de-epithelialized tissue offer superior facial skin color match in reconstructive surgery compared to other methods. This technique improves aesthetic outcomes in microvascular facial reconstruction.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Aesthetic Medicine
Background:
- Achieving optimal skin color match is crucial in microvascular facial reconstruction.
- Current reconstructive techniques present challenges in matching facial skin tones.
- Split-thickness skin grafts (STSG) are a common reconstructive tool, but their color-matching efficacy requires evaluation.
Purpose of the Study:
- To quantify the color match achieved with different microvascular facial reconstruction techniques.
- To evaluate a novel technique using STSG over de-epithelialized free tissue for improved skin color match.
- To hypothesize that STSG over de-epithelialized tissue yields better facial skin color match than free tissue with intact epithelium.
Main Methods:
- A cross-sectional photographic study involving 68 adult patients undergoing head and neck reconstructive surgery.
- Patients were categorized by reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adipofascial flap (STAFF), and STSG over myogenous flap (STMF).
- Color difference was calculated using delta-E, and blinded expert observers rated color match using a 10-point Likert scale.
Main Results:
- The mean delta-E values varied across techniques, with lower values indicating better color match (e.g., cervicofacial flap: 4.7, STAFF: 6.3, STMF: 8.8).
- Likert ratings also showed variability, with cervicofacial flap scoring highest (1.1) and RFFF lowest (2.4).
- Inter-rater reliability for Likert scale ratings was strong (coefficient = 0.80).
Conclusions:
- Split-thickness skin grafts (STSG) over de-epithelialized myogenous and adipofascial free tissue transfers generally provide a better color match than donor site skin paddles, with exceptions.
- Delta-E values derived from digital photographs demonstrated good correlation with expert visual assessments of color match.
- The study validates a reliable method for quantifying color match in reconstructive surgery, applicable for future research.
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