Full‐Thickness Skin Graft according to Surrounding Relaxed Skin Tension Line Improves Scar Quality in Facial Defect Coverage: A Retrospective Comparative Study

Abstract

A full-thickness skin graft (FTSG) is useful for covering small skin and soft tissue defects. In this paper, we suggest FTSG in consideration of the relaxed skin tension line (RSTL) concept for scar quality improvement since FTSG has disadvantages, including contour irregularities and mismatches of color and texture. We conducted a retrospective chart review of twenty-one patients with skin cancer on the face who underwent wide excision and FTSG by a single surgeon from October 2013 to July 2019. Twenty-one patients with skin cancer on the face were divided into RSTL-matched and RSTL-unmatched groups, and FTSG was performed. Each group was subjected to scar assessment three months after surgery. Observer assessment was performed by five independent observers using the observer component of the patient and observer scar assessment scale (POSAS) and Vancouver scar scale (VSS). Our results indicate that there were significant differences between the RSTL-matched and RSTL-unmatched groups in the VSS and POSAS components. In addition, the RSTL-matched group showed a natural appearance with surrounding tissue in the dynamic animation phase compared to the unmatched group. RSTL-matched FTSG can be an attractive option for face skin and soft tissue defect coverage. (An earlier version of this paper has been presented at the International Conference on PRS Korea 2020.)

Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects

“…Recently, there has been a trend toward aesthetic reconstruction, considering the concept of the facial subunit [ 9 , 10 ]. When considering these situations, skin grafting can be a relatively simple method for reconstruction, but patients may not be satisfied due to problems in terms of aesthetic reconstruction [ 11 ]. Therefore, various forms of local flaps that attempt to utilize surrounding tissues have been developed, including traditional bilobed flaps, Limberg flaps, and rotation flaps [ 9 , 12 , 13 ].…”

Early Diagnosis and Surgical Management of Cervical Necrotizing Fasciitis Caused By Pseudomonas Aeruginosa: A Case Report

“…Superficial facial defect closure with FTSG, matching the graft's RSTL to the surrounding RSTL can result in minimal scarring and better facial esthetics. 3 The nature of this disease makes early and aggressive treatment and surgical care with intensive support is vital 8 . Early detection is important because it can slow the course of the disease towards SIRS (systemic inflammatory response syndrome) and even death.…”

“…intravenous antibiotics. 3,4 Most cases start with trauma to the skin surface (eg, from a penetrating injury or even acupuncture needles), followed by the presence of bacteria. The infection starts in the deep tissue, and the epidermis may not be affected at first.…”

Repairing Small Facial Soft Tissue Defects by Tissue Regeneration in Asians

“…At present, there are various methods to repair facial soft tissue defects, including direct suture, skin grafts, local, regional, or free flaps. 2,3 Direct suture is a common method in the areas where the skin is lax and not easy to deform, but it also has some limitations of being easy to cause the skin to be pulled and deformed around the eyes, mouth, and nose. Skin graft has been rarely used in the repair of small facial soft tissue defects because of its differences in color, texture, and thickness between the skin graft and the recipient area.…”

“…In the reconstruction of facial soft tissue defects, one of the important surgical principles is to achieve the best results at the least cost. At present, there are various methods to repair facial soft tissue defects, including direct suture, skin grafts, local, regional, or free flaps 2,3. Direct suture is a common method in the areas where the skin is lax and not easy to deform, but it also has some limitations of being easy to cause the skin to be pulled and deformed around the eyes, mouth, and nose.…”