An Assessment on Clinical Outcome of use of Skate Flaps in Reconstruction of the Burned Nipple-Areola Complex

Abstract

Context: Nipple areola complex (NAC) is an essential part of breast reconstruction. It functions as an imperative aesthetic unit for the breast. Numerous surgical techniques to the gamut of NAC reconstruction such as skate flap, star flap, Swiss Roll flap, C-V flap, silicone rods, spiral flap made of residual scar tissue and tissue engineering and many others have been added. Despite the availability of surfeit of techniques, a simple reliable method to maintain nipple projection remains obscure. The purpose of this study was to demonstrate the advantages of Skate flap and tattooing in NAC reconstruction. Methods and Material:The NAC reconstruction Skate flap technique involved marking of the flap design on the patient's breast in afore tattooed scar tissue. Dermal flaps were raised with subcutaneous pedicle and closed with inverted dermal absorbable sutures followed by simple interrupted non-absorbable sutures. After this, full thickness skin graft was used to cover the adjacent donor defect to recreate the areola. The newly constructed nipple was guarded using a syringe barrel. This was done to avert compression on the anew nipple. This was left in place for up to 6 weeks. Surgical outcome was evaluated by recording post-operative complications, nipple projection at intervals and surgical revisions, if needed. Callipers were used to record projection of the nipple at the time of surgery and at 1, 3 and 6 months post-operatively. Results: A total of 26 NAC reconstructions in 19 post burn breast patients were performed over duration of 18 months employing Skate flap and tattooing. Mean nipple projection at time of surgery was 6.77 mm and 4.66 mm at end of 6 months follow up. There was a mean net projection loss of 31% at the end of 6 months post-operatively. Overall patient satisfaction on the outcome of reconstruction was generally favourable. No post-operative complications were noted. Conclusion: The study shows that the use of a Skate flap is a safe, easily performed, reliable and reproducible technique for maintaining projection in reconstructed nipples for a long period. Using the burnt scarred tissue helps in achieving excellent projection since contracture is somewhat lessened and also a more aesthetically pleasing nipple reconstruction is achieved matching the surrounding topography.