Epidermal Overgrafting Improves Coloration in Grafts and Flaps

Microsurgical free tissue transfer has provided great latitude in the restoration of form and function for defects of the head and neck area. Use of flaps and grafts from below the clavicles for reconstruction of facial defects frequently results in mismatch in coloration between the flap or graft and the adjacent facial skin. The reconstructed part, although functional and stable, stands apart from the facial milieu as a beacon defining the previous deformity. To improve the aesthetic appearance in these cases, most patients use camouflage make-up over the flap, but this can be a nuisance especially in male patients. An alternate method for improving skin coloration in flaps and grafts to the face is to remove the epidermis of the flap and resurface with scalp epidermis to provide complementary pigmentation that approximates the hue and natural tone of the face. In this study, the authors reported their experience with epidermal overgrafting for improving coloration in grafts and flaps to the facial region.

A retrospective review was carried out of 7 patients who underwent scalp epidermal overgrafting of remote grafts (3) and flaps (4) utilized for reconstruction of facial defects. All patients were males, with ages averaging 39.0 years (range: 19.8 to 68.3 years). The follow-up averaged 3.1 years (range: .6 to 9.0 years. Facial defects reconstructed included the forehead (2), nose (1), cheek (3), and orbit (1).

There were no skin graft losses. One graft exhibited prolonged chronic inflammation secondary to retained hair remnants. Color restoration was deemed to be excellent in 5/7 patients and good in 2/7 patients. Grafts exhibited hyperemic coloration for 3 to 6 months that gradually faded to approximate the adjacent facial skin tone. There were no incidences of hyperpigmentation. All donor sites healed uneventfully with full hair growth.

Epidermal overgrafting of remote flaps and grafts to the face is an effective means for effecting complementary facial coloration in skin flaps. This approach provides an additional adjunct for improving aesthetics in facial reconstruction and extends the reconstructive options to flap sites remote from the face. The applied scalp overgraft should be devoid of all follicular remnants so as to avoid chronic inflammation in the graft.