Summary
Introduction
Animal bites can result in extensive avulsion injuries of the face justifying microsurgical
replantation attempts. Reconstruction using local tissue harvesting increases the
local morbidity while distant tissues can result in colour and skin texture mismatching.
Skin grafting of the skin paddle by a split-thickness skin graft is a conventional
approach to help overcome this problem.
Patient and methods
An 18-year-old patient was treated for a chin avulsion after a dog bite injury. The
avulsed segment included the whole chin aesthetic unit and one-fifth of the lower
lip. The segment was replanted on the inferior labial artery. The replantation failed
and a reconstruction with a parascapular free flap was performed. Despite a debulking
at 1 month, the aesthetic result had a poor colour match. The technique used to improve
this was to de-epithelialise the skin and apply non-cultured autologous epidermal
cells (NCAECs) 100 days after the reconstruction.
Results
The reconstruction was uneventful. At 3 months follow-up, the patient was able to
purse her lips and had regained sensation. After 5 months, the free flap paddle was
consistent in colour, pigmentation and texture with the surrounding skin. At 10 months,
the patient’s only complaint was residual firmness in her scar and flap. The long-term
follow-up, over 23 months, confirmed the stability of the results.
Conclusion
The use of an NCAEC spray to treat the dyschromia on a parascapular flap used for
facial reconstruction is less invasive than split-thickness overgrafting and could
extend the use of distant flaps that have been avoided due to poor colour match.
Keywords
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Article info
Publication history
Published online: February 13, 2012
Accepted:
December 22,
2011
Received:
December 29,
2009
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
