Abstract
A full-thickness skin graft (FTSG) is useful for covering small skin and soft tissue defects. In this paper, we suggest FTSG in consideration of the relaxed skin tension line (RSTL) concept for scar quality improvement since FTSG has disadvantages, including contour irregularities and mismatches of color and texture. We conducted a retrospective chart review of twenty-one patients with skin cancer on the face who underwent wide excision and FTSG by a single surgeon from October 2013 to July 2019. Twenty-one patients with skin cancer on the face were divided into RSTL-matched and RSTL-unmatched groups, and FTSG was performed. Each group was subjected to scar assessment three months after surgery. Observer assessment was performed by five independent observers using the observer component of the patient and observer scar assessment scale (POSAS) and Vancouver scar scale (VSS). Our results indicate that there were significant differences between the RSTL-matched and RSTL-unmatched groups in the VSS and POSAS components. In addition, the RSTL-matched group showed a natural appearance with surrounding tissue in the dynamic animation phase compared to the unmatched group. RSTL-matched FTSG can be an attractive option for face skin and soft tissue defect coverage. (An earlier version of this paper has been presented at the International Conference on PRS Korea 2020.)
Highlights
Skin grafting is the gold standard for covering large-area skin defects when there are partial-thickness defects with intact underlying musculatures [1]
In the relaxed skin tension line (RSTL)-matched group, the graft was harvested at the donor site, trimmed according to the defect, and applied to facial defects in accordance with RSTL
The average observer scar assessment scale (OSAS) component of “total” in the RSTL-matched group was 10.98 and that in the RSTLunmatched group was 14.49, and there was a significant difference with a p value of 0.002
Summary
Skin grafting is the gold standard for covering large-area skin defects when there are partial-thickness defects with intact underlying musculatures [1]. To overcome the mismatch of texture and color, full-thickness skin was harvested through the donor site adjacent to the defect area [6]. When making an incision in the skin, the operator applies the incision considering the relaxed skin tension line (RSTL). This action ensures cosmetic and functional results by securing minimal tension when closing defects [7]. With this in mind, we thought there would be significant esthetic results when the RSTL of the FTSG was placed parallel to the RSTL of the recipient site. Satisfaction of skin graft through RSTL matching from the perspective of patients and observers
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