Surface-optimized free flaps for complex facial defects after skin cancer.
BACKGROUND
Advanced non-melanocytic skin cancer (NMSC) in the facial region causes extensive tissue loss, possibly coverable by local flaps. Remote free flaps are the reconstructive method of choice, despite disadvantages such as color and texture mismatch, and bulkiness with regard to facial skin.


METHODS
Post-ablative facial NMSC defects in four patients were reconstructed using remote free flaps, including radial forearm, scapular, parascapular, and anterolateral thigh flaps. Four months later, a split-thickness skin graft (STSG) was acquired from the retroauricular region to generate a non-cultured autologous epidermal cell (NCAEC) suspension. The flap surfaces were de-epithelialized, and the NCAEC suspension was sprayed onto the flap surface to improve the mismatch between facial and flap color. Debulking was also carried out. The aesthetic outcome was examined by photography and clinical examination 3, 6, 9, and 12 months after the first operation.


RESULTS
All flaps survived the 11- to 21-month follow-up. The secondary operation was accompanied by a delay in re-epithelialization in one case. No STSG donor-site problems occurred. Follow-up photographs showed significant improvements in the color and texture of the flaps.


CONCLUSIONS
Facial reconstruction with a free flap results in a mismatch of color and texture. Secondary correction of the flap surface by de-epithelialization and NCAEC application significantly improves the aesthetic outcome.
Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. K.-D. Wolff), Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: kesting@mkg.med.tum.de.
Marco Rainer
MR
Kesting
Department of Oral and Maxillofacial Surgery, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland G51 4TF, United Kingdom. Electronic address: colin.maciver@nhs.net.
Colin
C
MacIver
Department of Oral and Maxillofacial Surgery, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland G51 4TF, United Kingdom. Electronic address: craig.wales@nhs.net.
Craig J
CJ
Wales
Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. K.-D. Wolff), Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: wolff@mkg.med.tum.de.
Klaus-Dietrich
KD
Wolff
Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. K.-D. Wolff), Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: christopher-nobis@t-online.de.
Christopher-Philipp
CP
Nobis
Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. K.-D. Wolff), Klinikum rechts der Isar, Technische Universität Munich, Ismaninger Str. 22, D-81675 Munich, Germany. Electronic address: rohleder.nils@gmail.com.
Nils Hagen
NH
Rohleder
D000368:Aged; D017690:Cell Transplantation / Q000379:methods*; D000078404:Epidermal Cells; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D062326:Re-Epithelialization; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000601:surgery*; D012880:Skin Pigmentation; D014182:Transplantation, Autologous; D016896:Treatment Outcome
Facial neoplasms; Free tissue flaps; Re-epithelialization; Skin transplantation; Surgical flaps