Establishing a Clinically Applicable Methodology for Skin Color Matching in Vascularized Composite Allotransplantation

Abstract

Summary: Skin color matching in vascularized composite allotransplantation (VCA) is an important determinant of aesthetic outcomes. The process of color matching is infrequently described in the literature. The Pantone SkinTone Guide (PSTG) is a handheld tool comprised of realistic skin tone swatches with a corresponding virtual swatch system. A color match acceptability threshold (AT) is defined as the point beyond which >50% of observers deem a given skin tone pairing as unacceptable. In this study, color match acceptability thresholds were developed using the PSTG to help standardize donor-recipient color matching. Four representative colors were chosen across the skin tone spectrum. These standard colors were used to develop a survey asking participants to determine the acceptability of color pairings. Using survey results, ATs were determined for changes in lightness, undertone, and lightness and undertone combined for each of the standard colors. Inter- and intra-rater reliability were determined using Fleiss’s Kappa. Participants were more critical of skin tone pairings on the darker versus the lighter end of the spectrum, as evidenced by higher thresholds observed for lighter sample pairs. Additionally, observers were more critical of differences in skin lightness compared with differences in undertone. Intra-rater reliability was fair to substantial, and inter-rater reliability was fair to moderate. The PSTG can be used as a clinical tool to improve the aesthetic outcomes of skin-containing vascularized composite allotransplantation procedures by optimizing donor-recipient skin color matching. This can allow clinicians to complement visual judgment with quantitative reference.

Validating a Novel Device to Improve Skin Color Matching for Face Transplants

“…3 ), when the Delta E2000 rises above 5, there is a significant drop in the mean evaluator ratings. As mean evaluator ratings of 5 and above would be considered adequate for face transplant amongst most plastic surgeons, similar to the color match acceptability threshold of greater than 50%, 4 a Delta E2000 value of 5 or lower should be aimed for when identifying donors and recipients for face transplant.…”

“…When attempting to identify suitable matches for facial VCA, mean evaluator ratings greater than 5 would generally be considered adequate with regards to skin color likeness. A similar value was utilized in the study by Hoffman et al 4 in which a color match acceptability threshold of 50% was considered acceptable for skin tone swatches using the Pantone SkinTone Guide. As observed on the scatter plot (Fig.…”

“…Initial assessment is carried out by the organ procurement organization, followed by an in-person and photographic assessment by the treating surgeon. 4 …”

Penile Transplantation: Lessons Learned and Technical Considerations

“…Various teams also considered skin tone- (US1, US2) and age-matching (US2) in donors, which may aid recipients in psychologically accepting the allotransplant as self. 24 Given the variability of recipient genital neurovasculature, donor organ harvest must be anticipatory of recipient defect needs; the donor flap should therefore include sufficient pedicle length, a variety of donor vasculature and, if the external pudendal artery (EPA) is to be included, superficial abdominal tissue. We recommend harvesting the EPA in order to optimize allograft perfusion and avoid partial necrosis.…”

Trends, Gaps, and Collaboration in Facial Transplantation: A Bibliometric Study

“…1 This life-altering procedure, first pioneered in 2005 in Paris with a partial FT, is reserved for severe facial injuries not amenable to conventional reconstructive procedures. 2,3 The rapid growth in clinical experience and interest in FT has resulted in substantial growth in publications. However, the pace of clinical FT developments has exceeded that of the published literature.…”