The Tissue Efficiency of Common Reconstructive Design and Modification

Facial reconstructive techniques are capable of restoring a normal anatomic appearance despite the tissue loss resulting from skin cancer removal. Because none of these techniques recreate the lost tissue, most of these techniques require the removal of additional normal tissue in the form of Burow's triangles to achieve this goal. To analyze the quantity and potential variability of redundant tissue loss encountered during the use of conventional reconstructive techniques through the calculation of tissue efficiency. Conventional reconstructive designs were applied to a standard circular defect using computer-aided design software to determine the surface area of each closure design. Tissue efficiency was defined as the surface area of the defect divided by the total surface area of tissue loss after reconstruction. Island pedicle flaps (78.5%) and rhombic flaps (68.0%) offer the highest degree of tissue conservation among conventional flap designs. The majority of flap designs offer a significant improvement in tissue efficiency over the standard linear closure; they simply result in less overall tissue loss. A number of design modifications can limit or even reduce additional tissue loss while gaining significant advantages in flap mobility or tissue recruitment. The author has indicated no significant interest with commercial supporters.