title: Cosmetic outcomes following head and neck melanoma reconstruction: The patient's perspective.
abstract: BACKGROUND
  While studies have compared aesthetic outcomes following wide local excision of head and neck melanoma, none have evaluated this important outcome from the patient's perspective. Indeed, one could argue that the psychosocial impact of head and neck melanoma excision and reconstruction is more accurately assessed by deriving patient-based as opposed to surgeon-based outcome measures.
  
  
  OBJECTIVE
  To evaluate aesthetic outcomes following wide local excision of head and neck melanoma from the patient's perspective.
  
  
  METHODS
  Fifty-one patients who underwent excision of 57 head and neck melanomas followed by immediate closure by primary repair, skin grafting, local flap coverage or free tissue transfer were asked to complete a written survey at least six months after their surgery. A visual analogue scale (VAS) was used to assess the patient's perception of appearance alteration, satisfaction with his or her appearance, and emotional impairment. An ordinal scale was used to evaluate several criteria of the reconstructive outcome (pain, itching, colour, scarring, stiffness, thickness and irregularity).
  
  
  RESULTS
  Forty-two patients (82.4%) completed the survey. There were significant correlations between VAS scores reported for appearance alteration, satisfaction with outcome and emotional impairment (P=0.001). Patients who received skin grafts reported significantly unfavourable VAS scores compared with other methods of reconstruction (P=0.046). Moreover, skin grafts received significantly worse ordinal scale ratings for itching (P=0.043), colour (P=0.047), scarring (P=0.003) and stiffness (P=0.041) compared with other methods of reconstruction. Both skin grafts and free flaps were reported to have significantly less favourable thickness (P=0.012) and irregularity (P=0.036) than primary closure or local tissue transfer. There was no significant difference between patients undergoing primary closure with local tissue transfer (P>0.413). Other factors related to the patient's VAS scores included location of the melanoma (P=0.033), size of defect (P=0.037) and recurrence of melanoma (P=0.042).
  
  
  CONCLUSIONS
  The degree of emotional impairment following reconstruction of head and neck melanoma excision defects was correlated with the patient's perception of appearance alteration. From the patient's perspective, primary closure and local tissue transfer appeared to result in the highest aesthetic satisfaction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Buck
authors.forename: Vinay
authors.initials: V
authors.lastname: Rawlani
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wayne
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mustoe
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.forename: Robert
authors.initials: R
authors.lastname: Galiano
authors.forename: John Ys
authors.initials: JY
authors.lastname: Kim
keywords: Head and neck reconstruction; Local flap; Melanoma; Outcomes; Patient satisfaction