Objective Skin Quality Assessment after Reconstructive Procedures for Facial Skin Defects

Abstract

Local random skin flaps and skin grafts are everyday surgical techniques used to reconstruct skin defects. Although their clinical advantages and disadvantages are well known, there are still uncertainties with respect to their long-term results. Hence, the aim of this study was to evaluate outcomes more than one-year post operatively using objective measurement devices. The study included 31 facial defects reconstructed with local random flap, 30 facial defects reconstructed with split-thickness skin grafts (STSGs) and 30 facial defects reconstructed with full-thickness skin grafts (FTSGs). Skin quality was objectively evaluated using MP6 noninvasive probes (Courage + Khazaka GmbH, Cologne, Germany), which measure melanin count, erythema, hydration, sebum, friction and transepidermal water loss. The results showed that there were no significant differences in melanin count, erythema, hydration, sebum level, friction value and transepidermal water loss (TEWL) between the site reconstructed with random local flaps and the same site on the healthy contralateral side of the face. However, both FTSGs and STSGs showed significantly higher levels in terms of TEWL and erythema, whereas the levels of hydration, sebum and friction were significantly lower compared to the healthy contralateral side. Moreover, STSGs resulted in a significant difference in melanin count. These findings imply that the complex pathophysiology of the wound-healing process possibly results in better skin-quality outcomes for random local flaps than skin autografts. Consequently, this suggests that random local flaps should be implemented whenever possible for the reconstruction of facial region defects.

Keywords: facial surgery; reconstructive surgery; skin flap; skin graft; skin quality.

Figure 1

Comparison of the melanin difference between the random local flaps (N = 31), STSG (N = 30) and FTSG (N = 30) groups. Abbreviations: FTSG—full-thickness skin graft; STSG—split-thickness skin graft. * Kruskal–Wallis test with post hoc Dunn’s test. a vs. b—p < 0.05; a vs. c—p < 0.05; b vs. c—p < 0.05.

Figure 2

Comparison of the erythema difference between the random local flaps (N = 31), STSG (N = 30) and FTSG (N = 30) groups. Abbreviations: FTSG—full-thickness skin graft; STSG—split-thickness skin graft. * Kruskal–Wallis test with post hoc Dunn’s test. a vs. b—p < 0.05; a vs. c—p < 0.05; b vs. c—p > 0.05.

Figure 3

Comparison of the hydration difference between the random local flaps (N = 31), STSG (N = 30) and FTSG (N = 30) groups. Abbreviations: FTSG—full–thickness skin graft; STSG—split-thickness skin graft. * Kruskal–Wallis test with post hoc Dunn’s test. a vs. b—p < 0.05; a vs. c—p < 0.05; b vs. c—p < 0.05.

Figure 4

Comparison of the sebum difference between the random local flaps (N = 31), STSG (N = 30) and FTSG (N = 30) groups. Abbreviation: FTSG—full–thickness skin graft; STSG—split-thickness skin graft. * Kruskal–Wallis test with post hoc Dunn’s test. a vs. b—p < 0.05; a vs. c—p < 0.05; b vs. c—p < 0.05.

Figure 5

Comparison of the friction difference between the random local flaps (N = 31), STSGs (N = 30) and FTSGs (N = 30). Abbreviation: FTSG—full–thickness skin graft; STSG—split-thickness skin graft. * Kruskal–Wallis test with post hoc Dunn’s test. a vs. b—p > 0.05. a vs. c—p < 0.05. b vs. c—p > 0.05.

Figure 6

Comparison of the TEWL difference between the random local flaps (N = 31), STSG (N = 30) and FTSG (N = 30) groups. Abbreviations: FTSG—full–thickness skin graft; STSG—split-thickness skin graft; TEWL—transepidermal water loss. * Kruskal–Wallis test with post hoc Dunn’s test. a vs. b—p < 0.05; a vs. c—p < 0.05; b vs. c—p > 0.05.