Cosmetic Tattooing of Free Flaps following Head and Neck Reconstruction

Abstract

Free flap reconstruction of the head and neck is a widespread procedure. The aesthetic outcome is frequently compromised by color mismatch between the donor site skin and the complex pigmentation of the face. Various surgical procedures have been described to improve the appearance of external skin paddles. Medical tattooing is commonly used for nipple pigmentation in breast reconstruction and cosmetic procedures such as permanent makeup. This article describes the technique and its application to head and neck reconstruction. Medical tattooing can be used to improve the cosmetic appearance of head and neck free flaps. There is no donor site morbidity and subtle changes in color can be replicated. The article describes the technique of medical tattooing with the use of illustrative cases. Medical tattooing is a viable alternative for improving the appearance of cutaneous skin paddles following head and neck reconstruction with free flaps. Its advantages include no donor site morbidity, availability of an infinite range of colors, no requirement for general anesthesia, and the ability to use multiple colors in the one flap for complex pigmentation requirements. Its disadvantages include the need for specialized skills and equipment and the fading of color over time.

Dermatography (Medical Tattooing) for Scars and Skin Grafts in Head and Neck Patients to Improve Appearance and Quality of Life

“…Especially in the case of skin grafting or flap surgery, the wound is given sufficient time to heal before dermatography to ensure adequate perfusion and healing. 17 The results of the present study show that dermatography is a valuable adjuvant treatment option. The scores on the VAS pertaining to the appearance of the scar or skin graft improved after treatment by 4 points on a 10-point scale.…”

“…25 Instead of traditional ink that is used in decorative tattooing, inorganic metallic salts (eg, iron oxide dyes) and organic molecules (eg, tartrazine) are used as coloring agents in dermatography because of their structure that gives a more precise result. 17 The association be-tween tattooing and skin cancer is most likely multifactorial, including trauma induced by the procedure, a lifetime inflammatory reaction in an attempt to degrade all foreign material, and the ink content used. 25 However, a review by Kluger et al 25 concluded that the number of skin cancers arising in tattoos is low and that any association thus far should be considered coincidental.…”

“…18 Dermatography has few contraindications. 17 Complications mentioned in the literature are rare. Allergic reactions to tattoo composition have been described and can range from a lichenoid reaction to contact dermatitis.…”

“…Dermatography has few disadvantages, including the need for specialized skills and equipment and the fading of color over time. 17 In addition, it may mask the condition of the skin, making clinical follow-up and dermoscopy difficult. 27 It may also impede reflectance confocal microscopy, a cellular level in vivo imaging technique.…”

Reconstruction of major defects of the jaws

“…These include, but are not limited to, osteotomies of otherwise straight bones used in jaw reconstructions (Fig. ) to more curved contours, cosmetic tattooing to improve colour and facial prosthetics. Aesthetic considerations although very important, are of secondary concern when compared to function.…”