Beard reconstruction: A surgical algorithm.
OBJECTIVE
Facial defects with loss of hair-bearing regions can be caused by trauma, infection, tumor excision, or burn injury. The presented analysis evaluates a series of different surgical approaches with a focus on male beard reconstruction, emphasizing the role of tissue expansion of regional and free flaps.


METHODS
Locoregional and free flap reconstructions were performed in 11 male patients with 14 facial defects affecting the hair-bearing bucco-mandibular or perioral region. In order to minimize donor-site morbidity and obtain large amounts of thin, pliable, hair-bearing tissue, pre-expansion was performed in five of 14 patients. Eight of 14 patients were treated with locoregional flap reconstructions and six with free flap reconstructions. Algorithms regarding pre- and intraoperative decision making are discussed and long-term (mean follow-up 1.5 years) results analyzed.


RESULTS
Major complications, including tissue expander infection with the need for removal or exchange, partial or full flap loss, occurred in 0% (0/8) of patients with locoregional flaps and in 17% (1/6) of patients undergoing free flap reconstructions. Secondary refinement surgery was performed in 25% (2/8) of locoregional flaps and in 67% (4/6) of free flaps.


CONCLUSIONS
Both locoregional and distant tissue transfers play a role in beard reconstruction, while pre-expansion remains an invaluable tool. Paying attention to the presented principles and considering the significance of aesthetic facial subunits, range of motion, aesthetics, and patient satisfaction were improved long term in all our patients while minimizing donor-site morbidity.
Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen, Academic Teaching Hospital Technical University of Munich, Munich, Germany.
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M
Ninkovic
Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen, Academic Teaching Hospital Technical University of Munich, Munich, Germany. Electronic address: paul@heidekrueger.net.
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PI
Heidekrueger
Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen, Academic Teaching Hospital Technical University of Munich, Munich, Germany.
D
D
Ehrl
Nymphenburger Praxis für Plastische & Ästhetische Chirurgie, Munich, Germany.
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F
von Spiegel
Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen, Academic Teaching Hospital Technical University of Munich, Munich, Germany.
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PN
Broer
D000328:Adult; D000368:Aged; D000465:Algorithms; D000505:Alopecia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005153:Facial Neoplasms / Q000150:complications; D058752:Free Tissue Flaps; D005858:Germany; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000150:complications*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000009:adverse effects / Q000379:methods
Beard reconstruction; Facial defects; Facial reconstruction; Hair-bearing face; Mustache reconstruction; Pre-expansion