Good Color Match Research Articles

A new skin flap method for total auricular reconstruction in microtia patients with a reconstructed ear canal: Extended scalp and extended mastoid postauricular skin flaps

Before visiting a plastic surgeon, some microtia patients may undergo canaloplasty for hearing improvement. In such cases, scarred tissues and the reconstructed external auditory canal in the postauricular area may cause a significant limitation in using the posterior auricular skin flap for ear reconstruction. In this article, we present a new method for auricular reconstruction in microtia patients with previous canaloplasty. By dividing a postauricular skin flap into an upper scalp extended skin flap and a lower mastoid extended skin flap at the level of a reconstructed external auditory canal, the entire anterior surface of the auricular framework can be covered with the two extended postauricular skin flaps. The reconstructed ear shows good color match and texture, with the entire anterior surface of the reconstructed ear being resurfaced with the skin flaps. Clinical question/level of evidence; therapeutic level IV.

Management of Extended Orbital Exenteration using Spectacle retained Orbitofacial Prosthesis

ABSTRACTRestoration of facial defects is a challenge for both reconstructive surgeon and prosthodontist. There should be collective efforts from the restorative team involved in rehabilitation of the lost tissue to best of the form and esthetics. Orbitofacial defects warrant early and effective treatment protocol to allow incapacitated patients some level of social acceptance. A removable maxillofacial prosthesis which is closely adapted, well retained and with good color match is easily accepted by the patient. Retention of the orbitofacial prosthesis is achieved using various means, like implants, tissue undercuts, adhesives, magnets. A material chosen should be easy to manipulate and compatible to different retentive aids employed. This paper presents rehabilitation of extended orbital exenteration defect with spectacle retained orbitofacial prosthesis.How to cite this articleKumar KVA, Sahoo NK, Kumar D, Legha VS. Management of Extended Orbital Exenteration using Spectacle retained Orbitofacial Prosthesis. J Contemp Dent 2014;4(3):157-159.

Single Stage Reconstruction of Type IIA Defect of the Ear Lobule: The Limberg flap Technique Revisited.

The ear lobule is an important reference point for symmetry of the face and its loss causes an obvious aesthetic abnormality. Type II A defects are characterized by loss of the ear lobule without presence of a nubbin of tissue attached to the cheek. Such defects are typically seen in individuals having an unattached ear lobule. The goal of surgery should be an aesthetically pleasing reconstruction that maintains symmetry with the opposite ear lobule. The Limberg-flap technique using a doubled-over skin flap allows a one stage reconstruction of the ear lobule. It is technically simple and may be performed under local anesthesia. The aesthetic results are generally well acceptable and there is a good color match between the neolobule and the surrounding skin.

Free parascapular flap reconstruction of post burn neck contracture

Neck reconstruction for cervical scar contracture after burn injuries often takes priority over other areas. The ideal material for coverage of defects created by neck contracture release is thin, supple, large well vascularized healthy tissue. We present here our experience of seven cases of postburn neck scar contracture release and reconstruction with free parascapular flap cover. Patients and Methods: Seven adult females, 18-44 year age group, 6-15 months postburn, total body surface area 20-60% burns, moderate to severe contractures limited to the most visible anterior aspect of the neck were reconstructed with free parascapular flap. Results: All flaps survived with good aesthetic and functional mobility. Donor sites were closed primarily in all patients. Conclusion: Parascapular free flap reconstruction of postburn neck contracture is reliable and effective method. It provides large supple skin flap with good color match for esthetic and functional reconstruction of postburn neck scar contracture.

Use of the Supraclavicular Artery Island Flap for Reconstruction of Cervicofacial Defects

To describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervicofacial defects. Case series with chart review. Academic, tertiary referral center. Twenty-two patients with defects of the face, temporal bone, and neck were reconstructed with an SAI flap. Each defect was deemed unsuitable for primary or local flap closure and would require regional or free tissue transfer. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Mean follow-up was 7.4 months (range, 1-31 months). Statistical analysis was performed using SAS 9.1 (SAS Institute, Cary, North Carolina). Defects of the cervical skin (n = 10), face (n = 8), and temporal bone (n = 4) were reconstructed. Mean flap dimensions were 6.1 cm (range, 5-7 cm) wide and 21.8 cm (range, 16-28 cm) long. The proximal portion of the flap was deepithelialized to match the defect, resulting in a mean skin paddle length of 9.6 cm (range, 5-18 cm). Minor donor site dehiscence occurred in 3 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was no statistical correlation between flap necrosis and flap length (P = .3, χ(2)) or defect location (P = .13, χ(2)). The SAI flap is a viable alternative to cervicofacial advancement or microvascular reconstruction of cervicofacial defects in select cases. This flap is reliable, easy to harvest, and versatile, and it provides a good color match for cervicofacial defects.

Simultaneous Cheek and Lower Eyelid Reconstruction With Combinations of Local Flaps

Cheek defects are common facial defects, especially after tumor ablation. Although primary repair yields the best aesthetic outcome, wide defects require flap resurfacing. Among the flap techniques, the cervicofacial rotation/advancement flap is one of the most common. In cases with eyelid involvement, it is very unlikely that a local flap would single-handedly resurface the defect and additional flaps must be used.This article presents our clinical experience with 14 patients with cheek defects for whom cervicofacial rotation/advancement flaps were used. In 3 of the 14 patients, local flaps that include the laterally based Tripier flap, the Fricke flap, the nasojugal flap, and the median forehead flap were combined with the cervicofacial flap to reconstruct the lower eyelid defects in accordance with the principle of individually reconstructing different anatomic subunits. All infraorbital defects were resurfaced with residual cheek and cervical skin with a good color and texture match. In patients whose eyelids were intact, no malposition was observed.Posteriorly based cervicofacial rotation/advancement flaps offer a very reliable and convenient method for resurfacing infraorbital and medial cheek defects. When a lower eyelid defect is also present, its individual reconstruction as a separate facial subunit needs to be considered using a combination of smaller local flaps.

Use of the Supraclavicular Artery Island Flap for Reconstruction of Cervico‐facial Defects

Objectives: Describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervico-facial defects. Methods: Retrospective chart review in an academic, tertiary referral center of our first 18 consecutive patients undergoing SAI flap reconstruction for cervico-facial defects between 2010-2012. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Statistical analysis was performed using SAS 9.1. Results: Defects of the temporal bone (n=5), and cervical skin (n=13) were reconstructed. Mean flap width was 6.1cm (range 5-9cm). Mean flap length was 21.7 cm (range 16-28cm), with the proximal portion of the flap de-epithelialized to match the defect resulting in a mean skin paddle length of 10.3 cm (range 5-18cm). Minor donor site dehiscence occurred in 2 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was a significant correlation between flap length greater than 22 cm and flap necrosis (chi-sq p=0.01). No significant correlation between flap location and flap necrosis or dehiscence was found. 17 patients were happy with the cosmetic outcome of the flap. Conclusions: The SAI flap is a viable alternative to microvascular reconstruction of cervico-facial defects in select cases. This flap is reliable, easy to harvest, and versatile. It provides a good color match in the region. Flap complications and donor site morbidity were minimal and resolve with conservative measures. Flaps longer than 22 cm have a higher risk of skin necrosis.

Correction of hyperpigmented palmar grafts with full-thickness skin grafts from the lateral aspect of the foot

The palmar surface of the hand possesses special features when compared with the hair-bearing parts of the body. The same quality of skin has to be used in reconstruction of the palmar skin defects to restore normal function. The lateral aspect of the foot has similar features with the palmar region histologically and can be used for palmar reconstruction. Seventeen patients who had hyperpigmentation after skin graft in the palmar region were treated. Scar contracture was combined in seven patients. The hyperpigmented grafts were excised and then the defects were full-thickness skin grafted from the lateral aspect of the foot. The mean follow-up period was 13.7 (4–22) months. Engraftment was successful in 16 patients, but one failed due to haematoma. The colour of the graft was initially reddish, and then became similar to the palmar area. The donor site healed without any problem within 3 weeks. At follow-up these grafts had good colour and texture match with adjacent palmar skin. There was no hyperpigmentation. Minimal marginal scarring and scar hypertrophy occurred in four patients (24%). The skin of the lateral aspect of the foot is a good choice for palmar skin defects, because of the similarities in their characteristics. Results are acceptable in terms of minimal recurrence of scar contracture, no hyperpigmentation, adequate colour and texture match, and minimal marginal scarring and scar hypertrophy.

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction. The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required. This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.

Columella Lengthening by a Vascularized Preauricular Flap

A short columella can result in significant cosmetic and functional deformities. Various techniques such as local flap transfer and composite grafts have been reported for columellar lengthening, but the overall results remain unsatisfactory. Transferring a local flap cannot provide new tissue for the columella, which limits its application. Composite grafting can provide new tissue volume, and the composite tissue from the preauricular region has an excellent color and texture match. However, the lack of a stable blood supply for the composite graft restricts its clinical application due to problems such as viability, dimensions, and atrophy. To overcome these limitations, the authors harvested a vascularized preauricular flap for columella lengthening. Based on the superficial temporal vessels, the vascularized preauricular flap was harvested as a free flap and transferred to the columella region. The recipient vessels were angular vessels or facial vessels, and microsurgical anastomosis was performed between recipient vessels and the pedicle. The lateral femoral circumflex vessels were used as vascular grafts when the pedicle was not long enough. Eight patients who had short columellas were reconstructed with vascularized preauricular flaps. Six flaps were harvested in a reverse fashion, and the remaining two flaps were harvested in an anterograde direction. All the flaps survived well and showed a good color and texture match without hypertrophic scars. An average of 13.3mm improvement in length was obtained for the eight patients. Two patients underwent a secondary debulking procedure to thin the flap. The free vascularized preauricular flap procedure is a reliable method for columellar lengthening and has wide clinical application. 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 .

Supraclavicular Artery Flap for Head and Neck Oncologic Reconstruction: An Emerging Alternative

Aim. Head and Neck oncologic resections often leave complex defects which are challenging to reconstruct. The need of the hour is a versatile flap which has the advantages of both a regional flap (viz. reliable and easy to harvest) and a free flap (thin, pliable with good colour match). In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. Materials and Method. The flap was used as a pedicled fasciocutanous and was based on the transverse supraclavicular artery. We assessed this reconstructive option for complications as well as its and functional out comes. Results. Eleven cases underwent supraclavicular artery flap between 20011-2012 of which 5 were males and 6 females. Mean defect size was 5 cm × 6 cm. Nine donor sites were closed primarily and 1 required split skin grafting. We encountered one complete flap loss which was attributed to a band of constricting skin bridge over the vascular pedicle in a defect involving lateral third of midface. Two patient developed pharyngeocutaneous fistula (without flap loss) out of 3 patients who underwent augmentation pharyngoplasty post Near total laryngectomy. Conclusion. Supra clavicular artery flap is a thin versatile, reliable, easy to harvest, with good cosmetic and functional outcome at both ends (recipient and donor) for reconstructing head and neck oncologic defects.

Body hair transplantation in vitiligo

Hair transplantation has been used to repigment a stable vitiligo patch. Body hair transplant was done for a 28-year-old male with stable vitiligo with scarring. Peri-folllicular repigmentation was noted at 4 weeks and complete repigmentation of vitiligo patch was achieved at 12 weeks. No recurrence was noted at the end of 3-month follow-up with a good colour match with surrounding skin. To the best of our knowledge, this is the first case report highlighting the effectiveness of body hair transplantation by FUE in focal vitiligo patch with leukotrichia.

Perforator Plus Fasciocutaneous Flaps in the Reconstruction of Post-Burn Flexion Contractures of the Knee Joint

A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.

Upper forehead skin reconstruction with H-flap

Introduction:There are several options for forehead defect's reconstructions, including different local flaps, regional flaps, free flaps and skin grafts. We used double opposing rectangular advancement flaps (H-flap) in the upper forehead defects.Materials and Methods:This is a prospective case series study that has done in Plastic surgery ward. Of the 10 patients, six were women and four were men, their median age was 61 years (range 50-79 years). Mean follow-up of patients were 15 months and there was no recurrence during this time. We reconstructed forehead after excision of tumours in the same operation.Results:Aesthetic results of H-flap in all cases were great with patient satisfaction according to questionnaire sheets.Conclusion:This local flap is a reliable and safe way for upper forehead defects up to 6 cm lengths. Long-term follow up showed inconspicuous scars and good texture and colour match of the reconstructed forehead. We recommend this flap for upper forehead reconstruction in defects between 4 cm and 6 cm. Directions of incisions are parallel to resting skin tension line and length to width of flap considered 2:1 with excision of burrow triangle from both side. We used silicon sheet post operatively for 3 months for better aesthetic results.

Abdominoplasty and thoraco-epigastric flaps for large anterior trunk defects after dermatofibrosarcoma protuberans wide resection: Two illustrative cases

INTRODUCTIONExcision of large dermatofibrosarcoma protuberans in the anterior aspect of the trunk often results in large surgical defects that frequently dictate the need for microsurgical reconstruction. However, this option is not always available. PRESENTATION OF CASEThe authors describe two patients with very large anterior trunk dermatofibrosarcoma protuberans: one in the epigastric region and the other in the hypogastric region. In the patient with the hypogastric tumor, a classical abdominoplasty flap associated with umbilical transposition was used to cover the skin defect after muscle and fascial plication, and placement of a polypropylene mesh. In the patient with the epigastric tumor, a synthetic mesh was also placed, and the skin and subcutaneous defect was reconstructed with a reverse abdominoplasty flap and two thoraco-epigastric flaps. In both cases, complete closure was possible without immediate or late complications. DISCUSSIONThe local options described in this paper present several potential advantages compared to microsurgical reconstruction, namely they are easier and faster to perform and teach; they provide a good skin color and texture match; they are not associated with distant donor site morbidity; follow-up is usually less cumbersome; the post-operative hospital stay tends to be shorter; they are less costly; they are less prone to complete failure. CONCLUSIONThe authors believe that these two patients clearly show that local flaps, although frequently neglected, continue to be valid options for reconstructing large anterior trunk defects, even in the current era of microsurgery enthusiasm.

Free lateral tarsal flap transfer for repair of skin defects of the hand

Objective To explore the clinical efficacy of repairing hand skin defect by free lateral tarsal flap transfer.Methods Lateral tarsal flap free transplantation based on the lateral tarsal artery was carried out to repair skin defects of the hand in 35 cases.The size of flap ranged from 4 cm × 3 cm to 8 cm × 4 cm.Results All skin flaps survived.The follow-up time was 6 to 18 months.The flaps showed good texture and color match with no bulkiness.The sensory recovery was good and hand function was satisfactory.Conclusion The free lateral tarsal flap has a relatively consistent vascular pedicle.The flap is easy to dissect,thus is a useful option to repair small and medium size skin defects in the hand. Key words: Surgical flaps; Hand injuries; Lateral tarsal flap

Simultaneous Correction of Scars and Tissue Deficiency With Composite Grafts in Secondary Cleft Lip Deformity

In secondary cleft lip deformities, repetitive surgeries lead to increased tension and deformities in the upper lip, ultimately resulting in new deformities such as wide scars and a tight lip. The simultaneous correction of a wide scar and tissue deficiency in the upper lip is paradoxical unless sufficient tissue is supplied to the scant upper lip. The authors describe a method to transfer composite tissue for the improvement of secondary cleft lip deformities and present an analysis of the outcomes. Ninety-one patients with secondary cleft lip, a wide scar, and tight lip were enrolled. After complete excision of the scar, the defect was covered with a composite graft that included skin and subcutaneous fat. The results were rated by 2 investigators blinded to the image of the scar and the morphology of the upper lip. The skin color of the 25 grafts was analyzed using a narrowband spectrophotometer using the Commission International d'Eclairage L*a*b* color coordinates. All grafts survived without sequelae. The scores of the scar images and general morphology were 8.3/10 and 8.2/10, respectively. Spectrophotometric analysis displayed no differences between the composite tissues and normal upper lip skin in each color coordinate, indicating that the composite tissue had a good color match with a normal upper lip. The use of a composite graft on the upper lip can be a reliable option to correct a wide hypertrophic scar and tight lip simultaneously, resulting in a satisfactory scar image and an improvement of upper lip morphology.

Tissue expanders for soft tissue reconstruction in the head and neck area—requirements and limitations

The repair of skin defects in the head and neck region still poses a significant problem for many clinicians. Tissue expansion is described as a treatment option providing good color, texture, and thickness match of the expanded skin. Unfortunately, the complication rates for tissue expansion range from 0 to 48 %. Therefore, the purpose of this study was to investigate risk factors for the use of tissue expanders in head and neck reconstructions. Forty-nine patients with skin deficits in the head and neck area underwent tissue expansion. Sixty-two implanted expanders were analyzed regarding the various complications and the success rate. The success rate of treated patients was 37 (75.5 %) of all 49 included patients. The most frequent cause for the skin deficit was a tumor resection near the tip of the nose followed by skin deficits resulting after craniectomy. Interestingly, a higher number of expanders and a larger volume were significantly associated with a worse outcome. There was a trend of association between larger defect size and failure, too. The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area. Compared to distant or free flaps, it often offers a better cosmetic outcome. In very large defects (>100 cm(2)) or when more than two expanders are needed, the failure rate increases. In these cases, other treatment options are recommended. The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area.

Revisiting Gavello's procedure for single-stage reconstruction of the earlobe: The vascular basis, technique and clinical uses

Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest. To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice. The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe. Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area. Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite. The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.

Versatile Use of Submental Tissue for Reconstruction of Perioral Soft Tissue Defects

To obtain optimum aesthetic result, perioral soft tissue defects require reconstruction using similar tissue. The submental area has very similar characteristics to perioral soft tissue and consists of thin, pliable tissue with a perfect color match. Therefore, we have used submental tissues for reconstruction of perioral soft tissue defects and application of the techniques, and results are discussed in this article. Between February 2001 and April 2008, 14 perioral soft tissue reconstruction procedures using the submental tissues were performed. The defect was on the upper lip including nasal columella in 5 cases, mentum in 3 cases, and oral commissure including buccal cheek in 6 cases. The techniques that were used included composite graft in 3 cases, local advancement flap in 3 cases, pedicled flap in 5 cases, and free flap in 3 cases. Patients were followed up for 9 months to 5 years. During this period, no major complications were noted, and satisfactory aesthetic results were obtained. All transferred submental tissues survived. In all patients, donor defects were closed primarily except in cases of local advancement flap. The donor-site scar was inconspicuous and well hidden below the mandibular margin and did not restrict neck motion in all patients. In particular, hair restoration on the flap was excellent in male patients. We believe that the submental area can provide useful soft tissue for perioral soft tissue defects because it provides a good color and texture match with perioral skin and can be harvested with minimal donor-site morbidity.