Resident University of California San Francisco San Francisco , California
Background: Head and neck ablative surgery can impose severe disfigurement, particularly when cervicofacial skin is resected. Cutaneous defects are often reconstructed using skin paddles of microvascular free flaps; however, the resulting mismatched skin color represents a profound aesthetic challenge. Herein, we describe a method of using split thickness skin grafts (STSGs) over de-epithelized free flap skin paddles to improve color match. Additionally, the study demonstrates novel application of a handheld colorimeter to quantitatively measure the degree of color match achieved.
Learning Objectives: Learn a novel technique and understand how to use a handheld colorimeter
Study Objective: Determine whether STSGs over myogenous and de-epithelialized adipofascial free flaps improve color match
Design Type: Retrospective cohort
Method: Patients who underwent microvascular free tissue transfer involving skin were included. The study cohort had split thickness skin grafts placed over myogenous or de-epithelialized adipofascial free flaps at the time of initial reconstruction. Color match was assessed during follow-up using NixPro2, a validated handheld colorimeter device. DeltaE2000 color measurements were taken of free flap skin paddles, adjacent native skin, and donor site skin.
Results: Thirty-four patients were included, among them 11 underwent STSG to the free flap skin paddle. DeltaE2000 comparisons in the STSG group demonstrated improved color match to adjacent native skin (lower DeltaE2000), compared to the unaltered flap skin paddle cohort (3.1 versus 6.5, p=0.001). As validation control, there was no color difference between two areas of native skin in the two cohorts (2.3 versus 1.5, p=0.095).
Conclusion: STSG over de-epithelialized free flap skin paddles improves color match, which can be efficiently measured using an in-office colorimeter.