title: Improving the colour match of free tissue transfers to the face with non-cultured autologous cellular spray--a case report on a chin reconstruction.
abstract: BACKGROUND
  Animal bites can result in extensive avulsion injuries of the face justifying microsurgical replantation attempts. Reconstruction using local tissue harvesting increases the local morbidity while distant tissues can result in colour and skin texture mismatching. Skin grafting of the skin paddle by a split-thickness skin graft is a conventional approach to help overcome this problem.
  
  
  METHODS
  An 18-year-old patient was treated for a chin avulsion after a dog bite injury. The avulsed segment included the whole chin aesthetic unit and one-fifth of the lower lip. The segment was replanted on the inferior labial artery. The replantation failed and a reconstruction with a parascapular free flap was performed. Despite a debulking at 1 month, the aesthetic result had a poor colour match. The technique used to improve this was to de-epithelialise the skin and apply non-cultured autologous epidermal cells (NCAECs) 100 days after the reconstruction.
  
  
  RESULTS
  The reconstruction was uneventful. At 3 months follow-up, the patient was able to purse her lips and had regained sensation. After 5 months, the free flap paddle was consistent in colour, pigmentation and texture with the surrounding skin. At 10 months, the patient's only complaint was residual firmness in her scar and flap. The long-term follow-up, over 23 months, confirmed the stability of the results.
  
  
  CONCLUSIONS
  The use of an NCAEC spray to treat the dyschromia on a parascapular flap used for facial reconstruction is less invasive than split-thickness overgrafting and could extend the use of distant flaps that have been avoided due to poor colour match.
authors.affiliation: Plastic and Reconstructive Surgery Department, Henri Mondor Hospital, Assistance Publique des Hopitaux de Paris (APHP), Paris, France. mikaelhivelin@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Hivelin
authors.forename: Colin
authors.initials: C
authors.lastname: MacIver
authors.forename: J L
authors.initials: JL
authors.lastname: Heusse
authors.forename: M
authors.initials: M
authors.lastname: Atlan
authors.forename: L
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings / Q000175:diagnosis / Q000601:surgery*; D017690:Cell Transplantation / Q000379:methods*; D002680:Chin / Q000293:injuries* / Q000601:surgery; D004285:Dogs; D005151:Facial Injuries / Q000175:diagnosis / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D012867:Skin / Q000166:cytology*; D016038:Skin Transplantation / Q000379:methods; D014182:Transplantation, Autologous; D015599:Trauma Severity Indices