A trial on subcutaneous pedicle island flap for eyebrow reconstruction

Abstract

Introduction

Severe burn is a common problem affecting victim's eyebrows. This study aims to assess the effectiveness, complications and patients’ satisfaction in two eyebrow reconstruction surgical methods. Up to now, many reconstruction methods, their specific advantages and complications have been introduced. This study compares a new method (subcutaneous pedicle island flap), which is scarcely discussed, with a standard method (superficial temporal artery island flap).

Method

This is a clinical trial conducted during 2003–2005 at the Al’ Zahra’ Hospital. Forty patients with eyebrow defect due to burn injuries were selected by convenience sampling. They were allocated to two groups randomly. The control group underwent a surgery for ‘superficial temporal artery island flap’ and the case group for ‘subcutaneous pedicle island flap’. Data were gathered using two questionnaires. The first one included demographic data, patient history and condition of the eyebrows prior to surgery, effectiveness of surgery and complications. The second was a smiley face visual scale for patient's satisfaction. Data analysis was done using SPSS software (version 12; SPSS Inc., Chicago, IL, USA).

Result

Findings showed that in the control group, 80% were female of a mean age of 22 years (SD = 6/30) and in the case group 75% were female, of a mean age of 21/80 years (SD = 8/28). Fisher's exact test showed a significant difference between the type of surgery and hair-growth direction (p = 0.003). In addition, Mann–Whitney U test showed a significant difference between the type of surgery and patient satisfaction (p = 0.002). Analysis showed that there is no significant difference between the type of surgery and bleeding, congestion, flap necrosis, temporary hair loss in flap and donor-site alopecia (p > 0.05). Surgeon's experience shows that surgery time and learning curve in the case group is lower than that in the control group.

Discussion

Subcutaneous pedicle island flap is an appropriate and easy method with good efficacy, lower complication and more reasonable and acceptable patient's satisfaction. Therefore, this method is recommended for burn patients with eyebrow defects.

Introduction

Severe burn, trauma, tumour resection, tattooing, tattooing ablation and resection can all result in eyebrow defects. Eyebrow defects may be unilateral, bilateral, complete or partial. Burn is a common cause of eyebrow defects, and its repair is usually difficult because of its surrounding and adjacent areas [1]. Some problems in this area are scaring, tissue adhesions, etc. Furthermore, ectropion leads to additional problems in eyebrow reconstruction.

Eyebrows are an important factor of beauty. Regarding the protective role of eyebrow and its effect on beauty, its repair can play a significant role in patient's appearance, and therefore in his or her body image. The commonly recommended treatments in this area are (1) grafting from scalp or another eyebrow (this method has been in use for many years) and (2) superficial temporal artery island flap (posterior branch) [2], [3]. The second method has some problems such as extensive dissection, donor-site alopecia and unnatural hair-growth direction. It is a complex and time-consuming procedure. In addition, surgeons need significant time to gain expertise; so it has a long learning curve.

This study aimed to assess the effectiveness, complications and patient satisfaction with a new, special flap (subcutaneous pedicle island flap) in comparison with the classic superficial temporal artery island flap.