Abstract
BackgroundDystrophic skin scarring commonly occurs following skin cancer resections. In particular, the cosmetic outcome of skin graft reconstructions, following epidermoidal carcinoma removal, is generally poor due to wide marginal tumour excision, loss of subcutaneous tissues, and subsequent pigmented atrophic scarring of the graft coverage. Skin grafting sequelae need a three dimensional correction to restore either the epidermal layer or the dermal/subdermal volume and vascularization.MethodsThe surgeons combined CO2 laser ablation, subdermal lipofilling according to the Coleman’s technique and epidermal cell suspension autografting to correct wide depressed and dyschromic facial scar. The Authors applied this new technique on three nasal skin cancer resected patients: two of them actually need a longer follow-up, the third patient, a 48 yr old caucasian male, presented a skin grafting scar due to sclerodermiform basal cell carcinoma removal. This case is reported discussing pre-intra and post-operative records up to a complete twelve months follow-up.ResultsRecords at six and twelve months follow-up after surgery demonstrate a fully integrated skin graft and a good restoration of the treated area, presenting the same texture and pigmentation of the adjacent untreated skin. Optimal, stable three-dimensional skin cosmetic restoration was obtained in a single stage surgical procedure.ConclusionAutologous non-cultured epidermal cell suspension transplantation on an epidermal laser ablated skin area, in combination with lipofilling subdermal reconstruction, appears to be an effective, simple and time-saving method to correct skin graft sequelae, in skin cancer patients. This new technique allows to restore a three-dimensional morphological structure of the treated area and to recover a natural appearance of the skin at the same time. The Authors believe that this technique can be safely used to treat any kind of dystrophic scarring.
Highlights
Skin grafting reconstruction is widely used in patients who need surgical removal of cutaneous malignancies, but often leaves unpleasant, antiaesthetic and dystrophic scars
The Authors have started a surgical trial of skin reconstructions combining these two techniques in order to evaluate if a multiplanar treatment can provide, in a single stage operation, better results if compared with the traditional treatments
The technique that we have described associates, for the first time in a single surgical stage, the lipofilling for the volumetric correction of scar atrophy to the transplantation of keratinocytes and melanocytes for the revitalization and repigmentation of the epidermal layers
Summary
Skin grafting reconstruction is widely used in patients who need surgical removal of cutaneous malignancies, but often leaves unpleasant, antiaesthetic and dystrophic scars. Skin grafting otherwise is mandatory either for oncological follow-up or for the presence of multiple precancerous lesions on the skin surrounding to the area that needs reconstruction. It is used for wide defect muscular structures, where natural aging factors or pathological events have produced fat tissue loss or atrophy [2,3,4]. Mechanical or physical dermabrasion (cryotherapic or laser epidermal ablation) are widely used to prepare the surgical field for the cellular suspension autografting. The combination of both surgical options, lipofilling and epidermal cellular grafting, has never been attempted before in the same procedure. Skin grafting sequelae need a three dimensional correction to restore either the epidermal layer or the dermal/subdermal volume and vascularization
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