Aesthetic management of external skin paddles following microvascular reconstruction of the head and neck

Microvascular free tissue transfer has become a popular reconstructive option for a wide range of complex head and neck defects. Although highly effective in achieving wound closure, this technique frequently introduces skin paddles with inherent differences in thickness, color, and texture. In resurfacing of cutaneous facial defects, such disparity often leads to inferior aesthetic results. For patients, poor appearance following head and neck reconstruction can become a significant source of distress and add additional burden to their recovery. This article describes several options available in the postoperative setting to improve the appearance of transferred skin paddles. Regional tissue rearrangement with the submental and posterior scalping flaps is discussed in detail.