Free Tissue Grafts Research Articles

The Effects of Radial Cartilage Incision on the Growth of Rabbit Ear.

Recently, radial cartilage incision (first-stage) at an early age combined with free auricular composite tissue grafting (second-stage) can effectively correct the concha-type microtia with the moderate or severe folded cartilage in the middle and upper third auricle, but radial cartilage incision's effects on the growth of the ear remain to be determined. The authors aimed to evaluate the effects of radial cartilage incision in young rabbits model. Ten New Zealand white rabbits were included in our experiment. Two ears of each rabbit were divided randomly into two groups. The experimental group was operated with radial cartilage incision, and no intervention was given to the control group. The ear width, length, and perimeter were noted every two weeks. Auricular surface area was noted at 4 and 22 weeks old. The repeated measures ANOVA was used to describe ears' growth trend. A paired-sample's t test is conducted to test whether there are significant differences among the variables through the SPSS25.0 software. The growth tendencies of the ear length, width, and perimeter were observed and analyzed. The growth curves of the experimental ears were similar to that of the control. There was no significant difference in the increased ratio of surface area among the two groups. The cartilage of the experimental ears showed no change in biomechanical properties compared to that of control group. This study shows that radial cartilage incision at an early age does not influence the growth of rabbit ear length, width, perimeter, and surface area and also does not change the biomechanical properties of the cartilage. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Biomaterials derived from hard palate mucosa for tissue engineering and regenerative medicine.

Autologous materials have superior biosafety and are widely used in clinical practice. Due to its excellent trauma-healing ability, the hard palate mucosa (HPM) has become a hot spot for autologous donor area research. Multiple studies have conducted an in-depth analysis of the healing ability of the HPM at the cellular and molecular levels. In addition, the HPM has good maneuverability as a donor area for soft tissue grafts, and researchers have isolated various specific mesenchymal stem cells (MSCs) from HPM. Free soft tissue grafts obtained from the HPM have been widely used in the clinic and have played an essential role in dentistry, eyelid reconstruction, and the repair of other specific soft tissue defects. This article reviews the advantages of HPM as a donor area and its related mechanisms, classes of HPM-derived biomaterials, the current status of clinical applications, challenges, and future development directions.

Fat graft survival requires metabolic reprogramming toward the glycolytic pathway

Fat grafts are widely used as natural fillers in reconstructive and cosmetic surgery. However, the mechanisms underlying fat graft survival are poorly understood. Here, we performed an unbiased transcriptomic analysis in a mouse fat graft model to determine the molecular mechanism underlying free fat graft survival. We conducted RNA-sequencing (RNA-seq) analysis in a mousefree subcutaneous fat graft model on days 3 and 7 following grafting (n = 5). High-throughput sequencing was performed on paired-end reads using NovaSeq6000. The calculated transcripts per million (TPM) values were processed for principal component analysis (PCA), unsupervised hierarchically clustered heatmap generation, and gene set enrichment analysis. PCA and heatmap data revealed global differences in the transcriptomes of the fat graft model and the non-grafted control. The top meaningful upregulated gene sets in the fat graft model were related to the epithelial-mesenchymal transition, hypoxia on day 3, and angiogenesis on day 7. Mechanistically, the glycolytic pathway was upregulated in the fat graft model at days 3 (FDR q = 0.012) and 7 (FDR q = 0.084). In subsequent experiments, pharmacological inhibition of the glycolytic pathway in mouse fat grafts with 2-deoxy-D-glucose (2-DG) significantly suppressed fat graft retention rates, both grossly and microscopically (n = 5). Free adipose tissue grafts undergo metabolic reprogramming toward the glycolytic pathway. Future studies should examine whether targeting this pathway can enhance the graft survival rate.

An Algorithm for the Use of Free Tissue Graft Reconstruction in the Endoscopic Endonasal Approach for Pituitary Tumors

To identify factors associated with successful use of free tissue grafting versus vascularized reconstruction after resection of pituitary tumors. A retrospective chart review of 2 tertiary academic medical centers over 3.5 years was conducted. Variables assessed included age, sex, body mass index, pathology, extent of surgical exposure, cavernous sinus or suprasellar extension, intraoperative cerebrospinal fluid (CSF) leak, grade of leak, previous radiation, and previous surgery. Reconstructive techniques were divided into no reconstruction, free tissue grafts, and vascularized flaps. A total of 485 patients were included. Free grafts were used in 299/485 cases (61.6%) and were more commonly used with smaller approaches (P < 0.001). Larger exposure size and CSF leak grades 2 and 3 were associated with vascularized flap use (P < 0.001 and P= 0.012, respectively). Using multivariate regression, type of reconstruction could be predicted by increasing extent of approach, intraoperative CSF leak grade, and suprasellar extension (odds ratio [OR], 2.014, P < 0.001, 95% confidence interval [CI], 1.335-3.039; OR, 1.636, P= 0.025, 95% CI, 1.064-2.517; OR, 1.975, P < 0.001, 95% CI, 1.554-2.510, respectively). Postoperative CSF leak occurred in 9 of 173 patients (5.2%) with intraoperative leak and was not associated with any factors on analysis. We propose an algorithm whereby grade 1 CSF leaks in sellar and parasellar resections can be successfully reconstructed with a free graft. Vascularized flaps may be reserved for grade 2 or 3 intraoperative CSF leaks, extended approaches, or tumors with suprasellar extension.

The Use of A Buccal Free Fat Tissue Graft to Enhance Primary Soft Tissue Closure during Socket Preservation and Improve Ridge Contour at the extraction site: Presentation of the Technique, and Report of Case Series

The Use of A Buccal Free Fat Tissue Graft to Enhance Primary Soft Tissue Closure during Socket Preservation and Improve Ridge Contour at the extraction site: Presentation of the Technique, and Report of Case Series

Outstanding surgeon of the twentieth century, professor Natalya Ivanovna Butikova

The purpose of the study is to highlight the scientific, clinical, pedagogical and social activities of the outstanding maxillofacial and plastic surgeon, Doctor of Medical Sciences, Professor N.I. Butikova.&#x0D; Material and methods. Based on the analysis of domestic literature, as well as the life, professional activities and scientific works of Doctor of Medical Sciences, Professor N.I. Butikova to present her role in the formation and development of domestic maxillofacial and plastic surgery.&#x0D; Results. Information from the life of a well-known surgeon in our country, one of the patriarchs of Russian pediatric traumatology and maxillofacial surgery, Doctor of Medical Sciences, Professor Natalia Ivanovna Butikova, who turned 110 years old in 2020, is presented. The formation of N.I. Butikova as a doctor, researcher and teacher, her activities during the Great Patriotic War are noted. The main directions of her scientific activity in the development and improvement of methods for the treatment of gunshot injuries of organs and tissues of the maxillofacial region and neck, the rehabilitation of the wounded with defects in the jaws and tissues of the oral region using the methods of bone autoplasty and Filatov's stalk are highlighted. Natalya Ivanovna paid much attention to improving the treatment of face and neck burns and their consequences, as well as to surgical methods for eliminating mimic muscle paralysis. Its role in the development of oncostomatology, combustiology, pediatric traumatology and orthopedics is revealed. N.I. Butikova developed surgical methods for the treatment of syndactyly in children under the age of one year and the first years of life using zigzag incisions, improved the methods of free tissue grafting and plasty with split skin grafts, and proposed an apparatus for preventing secondary contraction of skin grafts during transplantation.&#x0D; Conclusions. It is emphasized that she was one of the pioneers of domestic maxillofacial surgery. N.I. Butikova, being one of the founders of domestic surgery, the creators of the school of pediatric traumatologists and orthopedists, as well as maxillofacial surgeons, is rightfully recognized as one of the patriarchs of national healthcare.

Penile skin length can be predicted before frenuloplasty during routine circumcision.

One of the restricting factors for surgical treatment of congenital anatomical pathologies of the penis is the skin structure. Thanks to its structure, the penis is a flexible organ structure, and the treatment can be completed without the need for a free tissue graft. Length changes are obtained on the ventral side of the penis by frenuloplasty. Our study aims to attain an objective formula that could noninvasively predict these changes on the ventral side before the procedure. In our study, 52 patients who were admitted for routine religious circumcision were included, and penile ventral and dorsal skin and inner mucosa lengths were measured before and after frenuloplasty, which is a part of the normal routine circumcision procedure and performed via the "pull and burn" method. Stitches were done to prevent scar formation in the frenuloplasty area. The results were used to estimate the length changes to be obtained on the ventral side by performing a regression analysis of the patient's weight, height, ventral and dorsal inner mucosa, and outer skin lengths. Result: Following frenuloplasty, an increase was detected in the ventral surface ranging from 20% to 177%. This increase was found to be predictable with 62.5% precision (P < 0.01) using the formulation established by assessing the ventral inner mucosa length from pre-procedure values. No significant result was determined in the regression analysis of the patients' other measurements (P > 0.05). Penile length changes that would occur following frenuloplasty can be calculated using a noninvasive method. Frenuloplasty, which would be performed without any vascular change, could be helpful in the surgical planning of some penile surgeries. More studies should be conducted on older boys, in anatomic deviations, and moreover, to establish a reliable formulation.

Use of Xenogenic Collagen Matrices in Peri-Implant Soft Tissue Volume Augmentation: A Critical Review on the Current Evidence and New Technique Presentation.

Plastic peri-implant surgical procedures aiming to increase soft tissue volume around dental implants have long been well-described. These are represented by: pedicle soft tissue grafts (rotational flap procedures and advanced flap procedures) and free soft tissue grafts (epithelialized, also called free gingival graft (FGG), and non-epithelialized, also called, connective tissue graft (CTG) or a combination of both. To bypass the drawback connected with autologous grafts harvesting, xenogenic collagen matrices (XCM)s and collagen-based matrices derived from porcine dermis (PDXCM)s have been introduced, as an alternative, in plastic peri-implant procedures. Aim: This review is aimed to evaluate and to critically analyze the available evidence on the effectiveness of XCMs and PDXCMs in soft tissue volume augmentation around dental implants. Moreover, a clinical case with a new soft tissue grafting procedure technique (Guided Soft Tissue Regeneration, GSTR) is presented. Material and Methods: An electronic search was performed on the MEDLINE database, SCOPUS, Cochrane Library and Web of Science. The electronic search provided a total of 133 articles. One hundred and twenty-eight not meeting the inclusion criteria were excluded. Seven articles of human randomized clinical trials were selected. A total number of 108 patients were treated with CTG, and 110 patients with XCM. Results: in peri-implant soft tissue augmentation procedures, XCMs seem an effective alternative to CTGs, associated with lower patient morbidity and lower operative times.

Utilization of Free Soft Tissue Grafts in Otoplasty: A Simple Yet Effective Way to Avoid Suture Extrusion.

Prominent ear deformity occurs in 5% of the general population and has been treated by otoplasty for many years to address the psychosocial challenges of having such a deformity. There is extensive literature but no consensus on the best method to address potential surgical complications, including suture extrusion. The aim of this article was to describe a surgical technique designed to reduce suture extrusion following otoplasty surgery by placing free soft tissue grafts between Mustardé sutures and postauricular skin. Two hundred and eleven patients who underwent otoplasties with soft tissue grafts between January 2017 and January 2020 were included in this study. All surgeries were performed by 2 facial plastic surgeons with more than 20 years of experience each, practicing in Toronto, Canada. Patients were followed up to assess for suture extrusion between 12 and 36 months (median, 21 months) postoperatively. The rates of suture complications and extrusion were compared with those previously reported in the literature. Only 2 patients out of 211 (0.47%) had unilateral suture extrusion and were treated with suture removal. This is dramatically lower than the upper values reported in the literature, which average 5.55% (range, 0%-22.2%). A soft tissue graft separating the Mustardé sutures and postauricular skin acts as a barrier, and can be used in conjunction with traditional surgical techniques. By adding this graft in the proposed manner, there is additional tissue reinforcing the suture repair, thereby reducing the rates of suture complications and extrusion without increasing the operative time.

Readmission Rates Following Major Head and Neck Surgery With Concurrent Tracheostomy.

To determine the influence of major head and neck procedures on readmission and complication rates following tracheostomy. A retrospective cohort study using the 2005 to 2017 National Surgical Quality Improvement Program (NSQIP) database. Current Procedural Terminology codes were used to identify tracheostomy patients and to define the underlying head and neck procedure. Patients under the age of 18 and with unknown pre-operative variables were excluded. Univariate and multivariable analyses were performed. A total of 3240 tracheostomy patients undergoing major head and neck surgery were identified in NSQIP. The 30-day mortality rate was 104 (3.2%) and 258 (9.0%) patients were readmitted. 637 (19.7%) patients had an unplanned return to the operating room. There were 1606 (49.6%) non-tracheostomy specific complications, which included 850 (26.2%) medical and 1142 (35.2%) surgical complications. On multivariable analysis, we found that the underlying procedures did not impact the risk of readmission (P > .05 for all). The underlying procedure was also not associated with unplanned return to the operating room except for thyroidectomies, which had a lower risk than free tissue graft reconstruction (OR = 0.53 (95%CI 0.31, 0.88), P = .018). While almost 1 in every 2 patients had a complication following major head and neck surgery that included creation of a tracheostomy, the rate of readmission is comparatively low and is not associated with the underlying procedure. These findings should reassure head and neck surgeons that properly managed tracheostomies do not constitute a disproportionate risk of readmission.

Outcomes in Pediatric Endoscopic Skull Base Surgery: A Systematic Review.

Objectives The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study aims to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents aged 0 to 18 years. Design A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Final inclusion criteria included: case series with more than 10 patients with pediatric patients aged ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting This study was conducted at a tertiary care medical center. Participants Children/adolescents aged 0 to 18 years who underwent endoscopic skull base surgery were participated in this study. Main Outcome Measures Patient demographics, pathology, reconstructive technique, intraoperative findings, intraoperative, and postoperative surgical complications were measured through this study. Results Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients aged 0 to 18 years met inclusion criteria for final analysis. Seven of the 12 studies discussed a single pathology. The most common pathology was a skull base defect causing cerebrospinal fluid (CSF) leak. The majority of skull base repairs were made with free tissue grafts. The most common postoperative complication was CSF leak ( n = 40). Twelve cases of meningitis occurred postoperatively with two of these episodes resulting in death. Conclusion Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

EVALUATION OF USING BUCCAL PAD OF FREE FAT TISSUE TRANSFER WITH IMMEDIATE IMPLANT PLACEMENT IN THE MAXILLARY POSTERIOR AREA (CLINICAL TRIAL)

Introduction: Implants placed immediately after tooth extraction; impose many challenges. One of them is the difference in size and form between the extraction socket and the simultaneously inserted implant. Soft tissue coverage of the implant area is considered substantial to attain bone filling adjacent to the implant. Objectives: Evaluation of free tissue graft of buccal pad of fat (BPF) for primary soft tissue closure with immediately placed implants in the maxillary posterior region. Methods: Ten patients aged between 20 to 45 years were selected from the outpatient clinic of Alexandria University requesting a dental implant to replace an unrecoverable maxillary posterior tooth. One stage surgery including tooth extraction, placement of an immediate implant, bone grafting material and autologous soft tissue graft from the buccal pad of fat was carried out. Clinical and radiographical follow up were done for six months. Results: 10 patients (6 females and 4 males; mean age 34 years) were followed for 6 months .Soft tissue healing, was uneventful with only minor postoperative complications. Bone density and bone thickness measurements were significantly improved after 6 months from implant placement with full bone recovery around the implants compared with the 3months results. Conclusion: Results of the study suggest that, the buccal pad of fat graft application is a new prospective modality for achieving primary soft tissue coverage over immediate implants. Keywords: immediate implants, buccal pad of fat, primary soft tissue coverage. Running Title: immediate implants with buccal pad of fat free graft.

The use of Nile Tilapia skin as an occlusive biological dressing for palatal wound healing: A case series

Recently, the use of type I collagen obtained from Nile Tilapia (Oreochromis niloticus) was proposed for the treatment of second and third-degree burning lesions and diabetic ulcers due to its occlusive and healing properties. The aim of this report is to describe the use of Nile tilapia skin as an occlusive barrier to protect palatal wounds after the removal of free autogenous soft tissue grafts. Two patients with a deficiency in the height of keratinized mucosa were indicated for treatment with free gingival grafts. The palatal donor area was covered with a Nile tilapia skin, stabilized by sutures. Seven days after surgery, patients returned for post-operative care. Patients’ reported outcomes were investigated by the use of a visual analogue scale and included pain, discomfort, impact on chewing and speaking. Analgesics consumption was also recorded. Standardized photographs were obtained to monitor wound healing. Patients were followed up for 30 days. Patients reported reduced pain levels, with low consumption of analgesics during the first week after surgery. No discomfort or difficulty in chewing or speaking was reported. No complications such as hemorrhage or edema were observed. These findings suggest that the Nile Tilapia skin may be an interesting alternative as an occlusive biological dressing in palatal wounds harvest of free gingival grafts.

A Concept of "Boundary Determination" by the Combination of a Local Flap and Free Tissue Transfer Useful for the Prevention of Postoperative Complications After Complex and Widespread Skull Base Reconstruction.

The transplanted tissue is sutured to the stumps of the bones in skull base reconstruction. Concerning reconstruction by free tissue transfer, it is difficult that the tissue is accurately sutured/fixed to a complex three-dimensional structure. The authors devised a technique in which free tissue transfer is combined with a local flap. A pericranial flap is sutured/fixed onto the irregular border between the cranial and nasal cavities. A free tissue graft is transplanted cranial or caudal to the determined border. Clinical presentation 1 is a patient with carcinoma of the frontal sinus (T4bN0M0). Resection of the frontal bone/nasal bone/medial and superior walls of the orbit, frontal lobectomy was performed. Clinical presentation 2 is a patient with carcinoma of the maxillary sinus (T4aN0M0). Extended total maxillectomy, simultaneous resection of the facial skin/temporal muscle were performed. There were no serious postoperative complications related to compression or occlusion of the cerebral parenchyma or paranasal sinus.

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth.

Mandibular anterior teeth are most frequently affected by gingival recession. However, data regarding mucogingival treatment aimed at root coverage in this specific location are limited. The purpose of this study was to systematically review the scientific literature and to use the meta-analytic approach to address the following focused question: "What is the effectiveness of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?" Studies were located by searching 3 electronic databases (Medline, Scopus, and Cochrane databases) and cross-referencing. Randomized and nonrandomized studies including at least 1 arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of gingival recessions (recession type [RT] 1 and RT2) located on the buccal aspects of mandibular centrals, laterals and canines, were included in the analysis. Primary outcome was mean root coverage (mRC), expressed in percentage, based on a 3- to 12-mo follow-up observation. A Bayesian single-arm network meta-analysis was performed to identify a treatment hierarchy of the different surgical techniques. Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mRC is associated with laterally positioned flap (LPF) + connective tissue graft (CTG) (91.2%) and tunnel (TUN) + CTG (89.4%), whereas LPF alone, coronally advanced flap (CAF) + CTG, and free gingival graft (FGG) showed lower mRC (79.1%, 78.9%, and 68.5% respectively). TUN + CTG provides significantly greater mRC compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain. Treatment hierarchy generated by an arm-based network meta-analysis model suggested that tunnel and laterally positioned flap, both in combination with connective tissue graft, may provide the greatest mean root coverage in the treatment of mandibular anterior recessions. The results of the present systematic review can be used by clinicians when deciding which approach to adopt when treating buccal gingival recessions on mandibular anterior teeth. In particular, procedures based on a laterally positioned flap or a tunneling technique, both in combination with connective tissue graft, seem to be the most predictable therapeutic decision.

Double Thread Suspension: A Novel Technique to Facilitate End-to-Side Venous Anastomosis With a Microvascular Coupling Device in Head and Neck Reconstruction

Microvascular free tissue transfer has become a mainstay for head and neck reconstruction, and vascular anastomosis is 1 of the most challenging aspects. This study aimed to explore a safe, convenient, and efficient technique for end-to-side venous anastomosis using the coupling device. We evaluated a novel surgical strategy, double thread suspension (DTS), by reviewing data collected in a consecutive series of 60 patients who underwent free tissue grafting after surgical resection of head and neck tumors. Patients who underwent end-to-side microvascular anastomosis using the microvascular coupler device were randomly divided into the DTS group (n = 30) and the traditional procedure group (TRA, n = 30), the demographic data, coupler size, anastomosis time, microvascular complications, and flap survival were determined. The optional size range of coupler devices in the DTS group is better than that of the conventional group, ranging from 1.5 to 4.0 mm compared with 2.0 to 4.0 mm. The average anastomosis time was 4.68 ± 0.43 minutes in the DTS group which was significantly lower than the conventional group that was 9.24 ± 1.46 minutes (P < .0001) . There was no statistically significant difference between the 2 groups in coupler related complications or flap survival. The novel DTS technique provides the advantages of lowering procedure complexity, reducing operative time, and preventing tearing of vessel wall, therefore making DTS-guided end-to-side anastomosis a safe, relatively straightforward, and reliable technique.

Free adipose tissue (FAT) graft pooling for severe dead space management

Complex lower extremity trauma with large soft tissue defects requires early wound coverage to reduce the risk of complications. In particular circumstances, however, local or free flaps may be contraindicated due to local or systemic issues. This study presents a helpful and effective salvage procedure for soft tissue reconstruction that uses autologous fat grafting combined with negative pressure wound therapy. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Evidence that osteogenic and neurogenic differentiation capability of epidural adipose tissue-derived stem cells was more pronounced than in subcutaneous cells

Background/aimThe management of dura-related complications, such as the repairment of dural tears and reconstruction of large dural defects, remain the most challenging subjects of neurosurgery. Numerous surgical techniques and synthetic or autologous adjuvant materials have emerged as an adjunct to primary dural closure, which may result in further complications or side effects. Therefore, the subcutaneous autologous free adipose tissue graft has been recommended for the protection of the central nervous system and repairment of the meninges. In addition, human adipose tissue is also a source of multipotent stem cells. However, epidural adipose tissue seems more promising than subcutaneous because of the close location and intercellular communication with the spinal cord. Herein, it was aimed to define differentiation capability of both subcutaneous and epidural adipose tissue-derived stem cells (ASCs).Materials and methodsHuman subcutaneous and epidural adipose tissue specimens were harvested from the primary incisional site and the lumbar epidural space during lumbar spinal surgery, and ASCs were isolated.ResultsThe results indicated that both types of ASCs expressed the cell surface markers, which are commonly expressed stem cells; however, epidural ASCs showed lower expression of CD90 than the subcutaneous ASCs. Moreover, it was demonstrated that the osteogenic and neurogenic differentiation capability of epidural adipose tissue-derived ASCs was more pronounced than that of the subcutaneous ASCs.ConclusionConsequently, the impact of characterization of epidural ASCs will allow for a new understanding for dural as well as central nervous system healing and recovery after an injury.

Esthetic management of multiple gingival recession by Zucchelli's coronally advanced flap with bioabsorbable collagen membrane

The importance of esthetics is increasing for the patients as well as for the dentist. Gingival recession is one of the most common causes of unesthetic appearance. Hence, it is important to maintain a balance between pink and white components. Various techniques have been used to cover gingival recession in the past. Coronally advanced flap (CAF) is most commonly performed among the free pedicle tissue grafts. This case report describes the esthetic treatment of multiple gingival recession by Zucchelli's CAF with bioabsorbable collagen membrane.

Surgical Management of Gingival Recession Using Free Gingival Autograft: A Case Report

Gingival recession leads to dentinal hypersensitivity, aesthetic problems, root caries, cervical abrasion and difficulty in oral hygiene maintenance. Managing gingival recession often is a great challenge for practitioners. Different surgical techniques have been advocated for root coverage like free soft tissue graft procedures free gingival graft and sub-epithelial connective tissue graft, pedicle soft tissue graft rotational flap and flap advancement, pouch and tunnel technique and guided tissue regeneration. This case report displays use of free gingival graft for management of patient of age 22 years with Miller’s Class I recession defect in lower left mandibular central incisor.