Epidermal overgrafting improves coloration in remote flaps and grafts applied to the face for reconstruction

BACKGROUND: Flaps and grafts applied to the face from sites below the clavicles are mismatched with regard to their coloration compared with normal facial skin. The color can be improved by removing the epidermis and overgrafting with a thin, split-thickness skin graft of scalp epidermis. This report reviews the authors' clinical experience using this technique. METHODS: A retrospective review of 15 consecutive patients who underwent scalp epidermal overgrafting of flaps and grafts to the face from July 1, 1995, through January 1, 2006, was performed. The resulting color was compared with the adjacent facial skin using a digital scale color analysis. Results were subjected to a Wilcoxon signed rank test. Scalp donor sites were evaluated for hair growth and density. RESULTS: Postoperative graft color analysis revealed significant improvement in graft/flap coloration compared with preoperative values. Evaluation of the scalp donor sites revealed no evidence of scarring, hair thinning, or hair loss. There have been no complications to date. CONCLUSIONS: This study is the first to demonstrate the feasibility of altering the coloration of flaps and grafts applied from remote body sites to the face using epidermal overgrafting from the scalp in Caucasian patients. Significant improvement in coloration in the treated areas compared with the adjacent facial skin has been demonstrated by this technique. The authors believe that epidermal overgrafting is a useful adjunct for enhancing color aesthetics in facial reconstruction and may well lower the threshold for use of remote flaps and grafts previously ignored because of poor color match.