Skin Color Match Research Articles

Skin Color Match in Autologous Breast Reconstruction: Which Donor Site Gives the Best Result?

Background: Color match of a reconstructed breast with the surrounding area is of importance for the overall aesthetic result. The objective of our study was to quantify the degree of color match achieved with different autologous breast reconstructions and to analyze the changes in color over time by analyzing digital photographs. Methods: 193 patients that underwent a delayed autologous breast reconstruction (DIEP, PAP, LAP, LD) were included. Standardized pictures from 242 flaps at 3 months and 9-12 months postoperative were analyzed and the L*a*b* values and delta E2000 (dE) values were determined to qualify the color match. The Kruskal-Wallis and Wilcoxon rank-sum tests were used for statistical analysis. Results: Initially, DIEP flaps had a significant lower dE value compared to LD (p=0.012) and PAP flaps (p < 0.001) when compared with the natural breast. PAP flaps showed a significant decrease after 9-12 months (p=0.003). Perception of color match was in all flaps comparable. Compared to the cleavage, at late follow-up, DIEP flaps had a significant higher dE value compared to LD (p=0.017) and PAP flaps (p < 0.001). PAP flaps presented a significant decrease of dE after 9-12 months (p =0.031). Abdominal skin presented no better skin color match in patients with PAP, LD, and LAP flaps. Conclusions: All analyzed flaps have a comparable color match with the surrounding tissue as well as with the contralateral breast about one year after surgery. The color of PAP flaps changes more, which leads to an improvement at a later follow-up.

Photometric Comparison of Skin Color Match between Abdominal- and Thigh-Based Free Flaps for Breast Reconstruction in Caucasian Patients".

With the increasing demand for autologous breast reconstruction, different surgical techniques have emerged to provide patients with the best possible result tailored to their individual needs. The upper thigh provides an alternative tissue resource in patients where abdominal based flaps are not feasible. While surgical outcomes and donor-site morbidity demonstrate favorable results using abdominal as well as thigh based free flaps for autologous breast reconstruction, the differences in skin constitution and color between the two flap donor-sites have not been investigated. From our flap data base, 60 patients who underwent unilateral secondary breast reconstruction with free DIEP or TMG flaps where randomly selected from our database. In both cohorts, postoperative pictures were used for photometric color evaluation of the reconstructed breast using the Delta E 2000 score at Time A (1.5 - 3 months), Time B (6 - 8 months) and Time C (12 - 20 months). Standard univariate descriptive statistics and group comparisons were performed. The DIEP flap demonstrated a better skin color match at Time A (p < 0.001), Time B (p = 0.003) and Time C (p = 0.009). Over time, both flaps showed improved Delta E 2000 values, and patient age was only associated with higher Delta E 2000 values in TMG flaps after 1.5 - 3 months (p = 0.021). The study provides the first objective analysis of skin color match in secondary autologous breast reconstruction. The DIEP flap reconstruction shows a preferable color match compared to the TMG flap. Both free flaps demonstrate an improved skin color match 12 - 20 months after secondary breast reconstruction.

Color Match following Free Flap Surgery in Head and Neck Reconstruction: A Colorimetric and Aesthetic Analysis.

Many options for free tissue transfer have been described for head and neck reconstruction. Although functional outcomes remain paramount, aesthetic considerations such as color match can be equally consequential for patient quality of life. It is important to understand differences in color match based on flap donor site for head and neck reconstruction. A retrospective review was performed of patients who underwent head and neck reconstruction with free tissue transfer at a tertiary care academic medical center between November of 2012 and November of 2020. Patients with documented photographs of their reconstruction and external skin paddles were considered. Patient demographics and surgery-specific factors were recorded. Objective differences in color match were obtained by calculating the International Commission on Illumination Delta E 2000 (dE2000) score. Standard univariate descriptive statistics and multivariable statistical analyses were performed. Lateral arm, parascapular, and medial sural artery perforator free tissue transfer performed favorably compared with other donor sites, whereas anterolateral thigh flaps had the highest average dE2000 scores. Differences in dE2000 scores were mitigated by postoperative irradiation of the flap site and with increasing time beyond 6 months postoperatively. The authors provide an objective assessment of external skin color match in patients undergoing free tissue transfer for head and neck cancer by donor site. Medial sural artery perforator, lateral arm, and parascapular free flaps performed well compared with traditional donor sites. These differences are more significant at the face and mandible when compared with the neck, but they diminish 6 months after surgery and with postoperative irradiation of the free flap skin paddle. Therapeutic, III.

Through a New Lens: Skin-Grafted Free Flaps and Objective Facial Skin Color Matching.

Background: Head and neck ablative surgery can impose aesthetic disfigurement, particularly when severe color mismatch exists between native and reconstructed facial skin. To date, the accuracy, objectivity, and modifiability of facial skin color matching remains poorly understood. Objective: To measure skin color match outcomes after head and neck reconstruction using handheld colorimetry. Methods: Patients undergoing complex head and neck reconstruction involving facial skin were included. A variety of skin paddle donor sites were studied, including split-thickness skin graft (STSG) placement over myocutaneous or adipofasciocutaneous free flaps after de-epithelization. Skin color match (deltaE) was measured during follow-up using a handheld colorimeter. Results: Forty-seven patients were included, with median age 69. The most common flap type was the anterolateral thigh (n = 31, 66%). Twenty patients underwent STSG to the skin paddle. DeltaE measurements among the patients with STSGs demonstrated better color match (lowest deltaE), compared with patients with unaltered skin paddles (3.4 ± 1.0 vs. 6.5 ± 2.5, p < 0.0001). Conclusion: We found the use of STSGs over de-epithelialized myogenous or adipofasciocutaneous flaps improves color match, as measured by handheld colorimetry.

Validating a Novel Device to Improve Skin Color Matching for Face Transplants.

A prospective study of 100 individuals was conducted. All participants were photographed and scanned with the Nix Color Sensor. Sixty pairwise comparisons were randomly generated. Skin color analysis was performed using photographs and the Nix Color Sensor. Delta E2000 values were compared to mean evaluator ratings using a Spearman correlation analysis. One hundred patients were included. A Spearman's correlation demonstrated a strong inverse correlation between Delta E2000 values and the mean evaluator ratings. The higher the mean evaluator rating for likeness, the lower the delta. A correlation coefficient of -0.850 demonstrates a statistically significant relationship (P < 0.01). When the Delta E2000 rises above 5 there is a significant drop in the mean evaluator ratings. As mean evaluator ratings of 5 and above would be considered adequate for face transplant amongst most plastic surgeons, an E2000 value of 5 or lower should be targeted when matching donors with recipients for face transplant. The Nix Color Sensor positively correlates to the plastic surgeon's perception of skin color and can serve as an adjunct in donor selection for facial VCAs.

Genital Reconstruction following Fournier's Gangrene.

Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and women, often requiring reconstruction. The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene. A literature search was performed on PubMed with the search terms "Fournier"s gangrene" "genital reconstruction" and "Fournier's gangrene phalloplasty." The European Association of Urology's guidelines on Urological infections were also consulted for recommendations. Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded. Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function.

Surgical Correction of Ectropion: Comparison Between Full Thickness Skin Grafts and Local Flaps

Objective: To compare the effectiveness of two reconstruction techniques, i.e., full-thickness skin graft and local flap, for patients undergoing reconstructive surgery for ectropion repair.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Department of Plastic &amp; Reconstructive Surgery, Dr Ruth K.M. Pfau Civil Hospital Karachi, from Feb to Aug 2020.&#x0D; Methodology: The study was conducted after acquiring approval from the Institutional Review Board of Dow University of Health Sciences. Patients advised repairing ectropion were admitted to the ward prior to a day or night of the procedure. The consultant surgeon decided on the operative management, either using a full-thickness skin graft or a local flap, depending on the type of ectropion.&#x0D; Results: 60 patients were recruited for the study, with 30 patients in each group. At follow-up of two weeks, one month, and three months’ skin colour match and pliability were significantly better in patients who received local flap than those treated with a full-thickness skin graft. Out of 30, 2 (6.7%) patients developed ectropion recurrence when they received full-thickness skin graft coverage, whereas ectropion recurrence was not observed in patients managed with local flap.&#x0D; Conclusion: Local flap appears to be more effective than full-thickness skin graft in achieving excellent aesthetic effects in patients who underwent correction of ectropion.

Advancement flaps

Local advancement flaps are a key tool in the armamentarium of the reconstructive surgeon. They can be used to repair small and large defects on all areas of the face with excellent skin color and texture match, limited donor site morbidity, and flexibility to hide scars. In this review, we outline common categories of advancement flaps and discuss common situations for their use.

Commentary: A technical revisit to the glabellar flap.

We have read an interesting article by Balchev et al. published in the current issue of IJO. They included 15 patients who were followed up over 36 months. The authors have described the use of glabellar flap (GF) to reconstruct medial canthal region defects. They have categorized the medial canthal region into the upper, medial, and lower zone in reference to the medial canthal tendon. They used V-Y glabellar rotation, advancement, or combined transposition flap techniques. By definition, the glabella is a region between the eyebrows that has potential skin to reconstruct surrounding areas like the medial canthus and nose.[1] The glabellar myocutaneous flap is a simple, safe, and effective procedure that provides anterior lamellae and vascular supply to the reconstructed region.[12] The advantages being similar skin color, texture, and thickness with minimal postoperative flap shrinkage or contracture.[123] Moreover, the vascular supply leads to faster healing with minimal collateral damage. Maloof and Leatherbarrow[4] (2000) provided a detailed description of the GF. They conceptualized the idea of anatomical and surgical medial canthus, the latter being much larger in area. The surgical medial canthus extended from the subbrow region (superior) to the upper cheek (inferior) and medially up to the midline over the nose. They believed that any reconstruction of surgical medial canthus could be performed using a glabellar V-Y flap. The critical factors in preoperative planning of GF include[4]: Size, depth, and location of the defect Orientation and alignment of the V-Y flap Depth of the medial canthus or nasal bridge prominence Age and skin texture of the patient. The smaller, shallower, and medial defects have favorable outcomes. The prominent nasal bridge or deep medial canthus will need a longer flap to reach up to the lateral edge of the defect. Younger patients have tighter skin that may have intraoperative implications. Skin marking is a vital part of the GF harvesting process. After the surgical excision of the lesion and determining its tumor-free margins, a surgical marker pen is used to draw the triangular or rectangular GF. The flap size depends on the size of the defect, distance from the glabella, and the depth of the medial canthus.[1234] The first arm of the V-shaped GF, arises tangentially from the superolateral edge of the defect, passes superomedial toward the midline apex. The second arm (preferably curved in shape) is fashioned at an acute angle, and its length is kept slightly longer to accommodate the bend of flap tissue [Fig. 1]. The flap should have a broad base for better vascular supply. The dissection should be limited to the skin and subcutaneous tissue, avoiding the involvement of corrugators and procerus muscles. The suture fixation of the flap base to the underlying periosteum prevents traction and preserves canthal concavity. The donor site should be closed in two layers—the deeper muscular layer (4-0 or 5-0 absorbable sutures) and the skin with 4-0 or 5-0 prolene or nylon (preferably horizontal mattress sutures). For larger defects, the extended, modified advancement flap, rotational flap, or bilobed GF can be used.[145]Figure 1: A glabellar flap fashioned for the reconstruction of left medial canthus lesion showing the first and second arms with a broad baseThe complex scenarios that may compromise the outcomes of GF include[4]: Young patients with tight forehead and facial skin Very deep medial canthus Dense hairs in-between eyebrows (synophrys) Large and irregular defect extending more laterally or inferiorly. The limitations of GF include consecutive midline forehead scar, medialization of the eyebrows, lymphedema, and flap uptake-related complications (necrosis, infection, etc.).[45] Nevertheless, the GF and its modifications constitute a simple, reproducible, and efficient technique providing excellent skin color match with satisfactory aesthetic and functional outcomes.[3]

Skin Color Match in Head and Neck Reconstructive Surgery.

To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match. We hypothesize that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue produces better facial skin color match than free tissue with intact epithelium. Cross sectional photographic study of reconstructed facial skin color match. Sixty-eight adults, who underwent head and neck reconstructive surgery, were divided into six categories based on cutaneous reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adiopofascial flap (STAFF), and STSG over myogenous flap (STMF). Averaged color samplings of the reconstructed defect and adjacent normal skin were taken from digital photographs. The color difference was calculated using the delta-E calculation. Blinded expert observers also rated the degree of color match. Nonparametric cohort contrast and correlation statistical analyses were performed. The mean delta-E's and 10-point Likert ratings for the ALT, fibula, RFFF, STAFF, STMF, and cervicofacial flaps were 11.6, 10.0, 7.7, 6.3, 8.8, and 4.7, and 5.1, 6.4, 2.4, 3.2, 2.7, and 1.1, respectively. Likert scale inter-rater correlation was strong, with coefficient=0.80. On average, STSG over de-epithelialized myogenous and adipofascial free tissue transfers produced a better color match than the skin paddles of donor sites, with the exception of the radial forearm donor site. Delta-E values obtained from photos correlated well with expert ratings of color match. This reliable technique for quantifying color match may be used in future studies. 3 Laryngoscope, 132:1753-1759, 2022.

Comprehensive Review of the Submental Flap in Head and Neck and Facial Reconstruction: What Plastic Surgeons Need to Know.

Since its first introduction by Martin and colleagues (1993) and with further revisions by Sterne et al (1996), the submental artery flap (SMAF) has proven to be an effective, reliable, safe, and valuable option in head, neck, and facial reconstructive surgeries. The SMAF utilizes a long pedicle based on the submental artery, a branch of the facial artery, which provides good reach to the lower two-thirds of the face with excellent cosmetic outcomes. It also maintains a good skin color match for facial and cervical defects with a mostly hidden donor site scar (in the majority of cases the donor site can be primarily closed after raising the flap). Although the use of the SMAF is associated with high patient and surgeon satisfaction along with low rates of complications, disadvantages including flap thickness and the hair-bearing nature of the submental skin, which may be problematic for coverage of orofacial defects, especially in male patients. Although it has been almost 30 years since its introduction, and the SMAF has been successfully used in over 500 reported cases of pediatric and adult patients, a comprehensive review of the different aspects of the SMAF is lacking in the medical literature.

Cervico-facial flap: a versatile option among various reconstructive options for skin defects in parotid surgery-our experience in a tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cutaneous defects of the cheek and external ear present a reconstructive challenge. Even when free flap reconstructions and tissue transfer are commonly proposed, fewer patients with these malignancies are candidates for lengthy reconstructive surgery. The cost effectiveness, time consumption, long waiting period of head and neck malignancy patients and less availability of reconstruction teams in developing countries like India, are challenging factors.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In our study, retrospectively 46 cases operated for parotid neoplasm were identified and the operative reports were reviewed from September 2018 to April 2021. Data on patient demographics, pathological diagnosis, defect type, type of flap used, co-morbid disease, and smoking history was collected. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean defect size was 4×5 cm, however for defects larger than 4×4 cm and lesser than 7 cm a cervico-facial flap was used for reconstruction. The average time for surgery was 2 and a half hours extra for the free flap reconstruction. Post-operative wound complications were higher in free flap reconstruction. Partial/DTN was observed in 16% patients and necrosis that needed intervention- 6% of all patients. Patients with cervico-facial flap reconstruction had an excellent final functional and cosmetic result, with good skin color and texture match.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The cervico-facial flap is a versatile technique with excellent vascularity and good esthetic outcome, which should be utilized liberally in the reconstruction of facial defects, slight modifications in the flap harvesting and careful selection of patient can give excellent results in moderate defects after parotid surgeries, especially in a resource limited country like India.&lt;/p&gt;

Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect.

The study sought to determine whether extended forehead flap by using part of the scalp combined with laser hair removal is a practical approach when repairing distal nasal defect. A retrospective study was conducted with 6 patients who underwent reconstruction of nasal defects with extended forehead flaps (including scalp combined with subsequent laser hair removal) at Shanghai Ninth People's Hospital between June 2016 and December 2018. Surgical data collected included age, causes of defects, sizes of defects, invaded nasal subunits, implantation of tissue expander, time elapsed between the formation of defects and surgical treatments, sessions of laser hair removal, and follow-up results. All patients had nasal defects after removal of a benign nevus (diameter, >1.5 cm), which invaded distal nasal subunits (including the nasal tip, soft triangle, columella, and nasal ala) and could not be repaired using adjacent tissue. Preoperative and postoperative assessments of esthetic outcomes were analyzed, including skin color and texture match, appearance deformity, and scar appearance. All 6 female patients (ages 4 to 24 years) accepted the extended forehead flap technique and subsequent laser hair removal treatments. Among the 6 patients, 2 had nasal tip defects, 1 had a columella nasi defect, one had an alar defect, and 2 had multiunit defects. All transferred forehead flaps survived with no necrosis and underwent 2 to 5 subsequent laser hair removal treatments. The color and texture of the transferred flaps was similar to the adjacent skin in all patients. All patients were satisfied with the final outcome of the reconstructed nose with no obvious scarring during follow-up. Extending the forehead flap using the scalp is a practical and safe approach for the repair of large and distal nasal defects. Subsequent laser hair removal can eliminate the hair follicles of the scalp and improve the appearance and color of the flap.

Posterior auricular artery free flap reconstruction of the retroauricular sulcus in microtia repair

Autologous repair using costal cartilage grafts remains the most widely accepted method of microtia reconstruction. A major complication of current techniques is loss of ear shape caused by scarring, contracture and cartilage absorption. We present a new surgical technique utilizing the posterior auricular artery free flap in microsurgical reconstruction of the retroauricular sulcus in microtia. Reconstruction is performed in two stages. In the first stage, a fabricated costal cartilage framework is inserted into a skin pocket as described by Nagata. In the second stage, the ear framework is elevated from the scalp and held by an additional cartilage wedge. Following indocyanine green angiography perforator mapping, a posterior auricular artery perforator flap is harvested from the contralateral (normal) ear and used to reconstruct the posterior auricular sulcus covering the cartilage framework and elevating wedge. The technique was applied to three patients aged 11-15 years with a follow-up time of 8 months to 3 years. The average flap artery diameter was 0.73 mm and the vein was 0.7 mm. Venous congestion occurred in one case and was resolved with a vein graft leading to complete flap recovery. Good ear shape, elevation, projection, skin color and texture were achieved in all the cases. Posterior auricular artery flap reconstruction of the retroauricular sulcus in microtia repair is a useful alternative to the current skin graft and tissue expander-based techniques. It provides the ideal skin color and texture match and may improve the overall results of microtia reconstruction by enhancing vascularity.

Combination of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option in orbital exenteration.

To describe a combinatory technique made of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option after orbital exenteration. We retrospectively reviewed all patients who underwent orbital exenteration and subsequent reconstruction with this technique at our Head and Neck Department, Divisions of Ophthalmology and Otolaryngology, at San Raffaele Hospital, Milan, Italy. Three patients were treated with the aforementioned technique, following orbital exenteration due to malignancies. All of them were affected by recurrent diseases arising from the ocular components or periorbital structures: one basal cell carcinoma and two squamous cell carcinomas. Excellent result was achieved considering skin texture and colour match, aesthetic results and intra and post-operative complications (only minor, surgically controlled haemorrhage and minimal dehiscence subsequent to defective healing occurred). The proposed technique can be considered by the head and neck reconstructive surgeon as a good option in extended orbital exenteration.

Have We Achieved Optimal Skin Color Matching in Partial Facial Transplantation? A Survey Study of the General Public and Medical Professionals.

Skin color matching is an essential factor in achieving optimal aesthetic outcome in partial facial transplantation. However, there is no published literature evaluating the success of color matching to date. Furthermore, a medical professional's perception of an optimal color match may not necessarily translate to that of the general public. The purpose of our study was to evaluate skin color matching between the donor allograft and recipient native tissue in partial facial transplantations to determine the level of success perceived by the general public and medical professionals. Published photographs of partial face transplant recipients were used to create a survey where recipient native and donor allograft skin samples were juxtaposed. Thirty-three members of the general public and 30 medical professionals were asked to rate skin color match on a scale from "excellent match" to "not a match." Overall, 47% of given ratings were positive, indicating an "excellent" or "good match," and 53% of ratings were negative, indicating a "poor match" or "lack of match" between the skin sample pairings shown. Of the 19 partial face transplant patients who were rated, 9 patients received >50% positive ratings, and 10 patients received <50% positive ratings. Medical professionals consistently gave more positive ratings, with statistically significant differences in 7 of the 19 rated patients (P < 0.05). The results suggest that there is need for improvement in color matching in partial facial transplantation, and that the general public is more critical of skin color matching compared to medical professionals.

Extensive Facial Reconstruction Using Thickness-controlled Perforator Free Flaps.

Background:Although small and medium facial defects can be reconstructed with local flaps to ensure skin color and texture matching, extensive facial defects require the application of free flaps, including perforator free flaps. We hereby propose a personalized strategy for facial reconstruction to overcome these limitations, based on the use of free flaps accompanied by local flaps and thickness-controlled perforator flap concept, for extensive facial defects.Methods:A series of consecutive facial reconstructions were performed from 2006 to 2016 in the Plastic and Reconstructive Surgery Department of our institution. Only extensive facial defects greater than 40 cm2 were included in this study.Results:A total of 323 patients underwent reconstruction using free flaps with or without local flaps, from November 2005 to March 2019. Of these, 79 extensive facial surface reconstruction cases were analyzed retrospectively. The size of the defects, their areas (upper, middle, or lower third of the face), and the method of reconstruction were analyzed. This led to the development of a personalized reconstruction procedure for extensive facial defects. These extensive facial reconstruction cases included 24 defects of the upper third of the face, 43 cases of the middle third, and 12 of the lower third. Four cases addressed the middle and lower thirds simultaneously.Conclusions:The facial surface reconstruction strategy I suggest in this study is based on the flap selection, thickness-controlled perforator flap elevation, and combination of local and free flaps. We expect this procedure will improve the treatment and resolution of extensive facial defects.

Establishing a Clinically Applicable Methodology for Skin Color Matching in Vascularized Composite Allotransplantation.

Summary:Skin color matching in vascularized composite allotransplantation (VCA) is an important determinant of aesthetic outcomes. The process of color matching is infrequently described in the literature. The Pantone SkinTone Guide (PSTG) is a handheld tool comprised of realistic skin tone swatches with a corresponding virtual swatch system. A color match acceptability threshold (AT) is defined as the point beyond which >50% of observers deem a given skin tone pairing as unacceptable. In this study, color match acceptability thresholds were developed using the PSTG to help standardize donor-recipient color matching. Four representative colors were chosen across the skin tone spectrum. These standard colors were used to develop a survey asking participants to determine the acceptability of color pairings. Using survey results, ATs were determined for changes in lightness, undertone, and lightness and undertone combined for each of the standard colors. Inter- and intra-rater reliability were determined using Fleiss’s Kappa. Participants were more critical of skin tone pairings on the darker versus the lighter end of the spectrum, as evidenced by higher thresholds observed for lighter sample pairs. Additionally, observers were more critical of differences in skin lightness compared with differences in undertone. Intra-rater reliability was fair to substantial, and inter-rater reliability was fair to moderate. The PSTG can be used as a clinical tool to improve the aesthetic outcomes of skin-containing vascularized composite allotransplantation procedures by optimizing donor-recipient skin color matching. This can allow clinicians to complement visual judgment with quantitative reference.

Novel technique for the direct closure of the radial forearm flap donor site defect with a local bilobed flap.

The donor site defect remains the major disadvantage of the radial forearm free flap (RFFF). The purpose of this case series was to evaluate the effectiveness and safety of a local bilobed flap in direct closure of the RFFF donor site defect. Between February 2017 and July 2017, a prospective study was designed with 13 patients who had undergone RFFF reconstruction of the oral cavity. The primary purpose was to assess the effectiveness and safety of a bilobed flap closure of the RFFF donor site with primary healing. The late endpoint was to evaluate functional morbidity of the donor hand by comparing preoperative and postoperative outcomes. The donor site defect healed primarily in 12 of the 13 patients. A small area of skin necrosis (4%) developed in one patient, which was managed conservatively and healed by secondary intention. A significant reduction of wrist extension (mean difference [MD] = 2.64°, P = .01) and grip strength (MD = 3.68 kg, P = .04) was observed between preoperative and postoperative measurements. No statistically significant difference was observed regarding flexion, radial deviation, ulnar deviation, supination, pronation and pinch strength (P > .05). The bilobed flap is a reliable and effective method for closure of a RFFF donor site defect, ≤5 cm in greatest length. The advantages are excellent regional skin color match and avoidance of a second donor site and its inherent complications.

Local facial flaps: a workhorse for reconstruction of facial malignancies defects

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Face represents complete personality of a human being, so adequate cosmetic correction of facial defects arising due to skin malignancy is very important. After excision, treatment option varies according to size and location of defect for small- or moderately-sized circular defects. In our study, we have evaluated versatility of local flap of face.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We have included 30 cases of skin malignancy on face in our Institute within the period of June 2016 to May 2018. 20 patients (66.6%) were male and 10 patients (33.3%) were female, in age group from 45 to 65 years. 17 cases had basal cell carcinoma, 10 cases had squamous cell carcinoma and 3 cases had malignant melanoma. Tumours were excised with safe margins and defects reconstructed with local facial flaps. We evaluated the early postoperative complications and after 6months, cosmetic outcome and patient satisfaction was evaluated. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 30 patients with small to medium-sized defect (3-6 cm), 8 cases were managed with V-Y advancement flap, 7 cases nasolabial flap, 8 cases forehead flap and, 4 cases Limberg flap, 4 cases cheek advancement flap. Postoperatively none of the cases had complications and the functional and aesthetic outcomes were quite acceptable. Aesthetic results were excellent in 15 patients (50%), while in 8 patients good results (27%) and 5 patient fair results (17%) after 6 month.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Local facial flaps are the simple and best option to reconstruct the small to medium size facial malignancies defects and provides excellent skin colour and texture match with gives good aesthetic result.&lt;/p&gt;