Facial Defect Reconstruction with Scalp Skin Grafts

Abstract

The objective of this study is to demonstrate the benefits of scalp-based split-thickness skin grafts as a reconstructive modality for facial skin defects, noting advantages relative to traditional harvest sites. The study is presented as a case series with chart review set in a tertiary referral center. We reviewed the charts of patients with facial skin defects whose reconstruction required more skin than could be harvested with standard full-thickness skin grafting techniques and, accordingly, included a split-thickness skin graft from the adjacent scalp. Preoperative and postoperative photographs, along with operative and postoperative records, were used to evaluate final cosmetic results and complications. We reviewed 15 patients, with ages ranging from 6 to 90 years. Common indications were skin cancer resection, avulsive skin trauma, and ear reconstruction. While patients generally had good cosmetic outcomes, with excellent color matching relative to traditional distant donor sites, a major advantage of the scalp donor site was low donor-site morbidity. Scalp donor sites were commonly reepithelialized at 7 to 10 days postoperatively and had low reported pain scores. There were no major complications. Reconstruction of facial skin defects that require skin coverage with split-thickness skin grafts can optimally be harvested from adjacent scalp skin, providing adequate cosmesis but, perhaps most importantly, much lower donor-site morbidity than with traditional nonhair-bearing donor sites.

A systematic review of the scalp donor site for split-thickness skin grafting

“…The use of dermatomes with a depth setting of less than 0.016 inches showed higher early complication rates than the total early complication rate in five articles [4][5][6]10,23] and higher late complication rates than the total late complication rate in eight articles among 15 articles [2,5,6,[10][11][12]21,23]. Among the six articles [3,7,13,19,24,28] that reported the relevant data, a dermatome depth setting of 0.016 inches or more showed a higher early complication rate than the total early complication rate in one article [7], a higher late complication rate than the total late complication rate in one article [3], and higher early and late complication rates than the total early and late complication rates in one article [13]. Overall, the rate of early and late complications did not seem to be related to the depth setting of the dermatome.…”

“…In terms of sex distribution, male patients were predominant in most articles [11,14,15,[17][18][19][22][23][24][25], except for two articles [5,28]. Fifteen articles did not mention the sex distribution.…”

“…Four articles [5,25,17,25] did not mention the injection level. Two articles did not use tumescent solution [24,26]. The depth setting of the dermatome was less than 0.016 inches in 17 articles and 0.016 inches or more in seven articles [3,7,13,14,19,24,28].…”

“…Two articles did not use tumescent solution [24,26]. The depth setting of the dermatome was less than 0.016 inches in 17 articles and 0.016 inches or more in seven articles [3,7,13,14,19,24,28]. Three articles [6,8,9] did not mention the depth setting (Table 1).…”

“…In seven articles [11,12,[22][23][24]26,28], the solutions were administered topically on the donor wounds. The injection levels of tumescent solution were at the subgaleal or areolar layer in 15 articles [3,4,7,8,10,11,[14][15][16]19,20,22,23,27,28], subcutaneous tissue in six articles [2,6,9,12,13,18], and intradermal [21] and additional dermal or subdermal tissue [11] in one article each.…”