EPIDERM Technique: Safety and Outcomes of Skin Grafted Free Flaps in Head and Neck Reconstruction

Objectives: While prior studies have demonstrated favorable aesthetic outcomes using skin grafted free flaps to improve recipient site color match (Epithelial Preservation Including Dermal Resection Microvascular technique: EPIDERM technique), the clinical safety of this approach has not been established. Manipulation of the skin paddle potentially impairs free tissue monitoring and therefore may affect success rates. This study aims to compare perioperative outcomes in patients undergoing head and neck free flap reconstruction with and without the EPIDERM technique. Methods: A retrospective 1:1 matched cohort study was conducted involving 138 patients who underwent free flap reconstruction between January 2022 and December 2024 at a single tertiary care center. Patients were matched by flap type to control for variations in reconstructive technique and defect site. Data collected included demographics, defect characteristics, flap type, operative time, perioperative complications, reoperations, and hospital length of stay. Results: Defect distribution differed between groups, with scalp defects more common in the EPIDERM group (p = 0.05) and oropharyngeal and mandibular defects more frequent in the standard group (p < 0.01, p = 0.02). Despite these differences in defect distribution, no significant differences were observed in flap viability, wound complications, reoperation rates, hospital readmissions, or length of hospital stay between the color match and non–color match groups. Conclusion: The EPIDERM technique represents a safe adjunct to head and neck free flap reconstruction, offering the potential for improved aesthetic outcomes with no apparent increase in perioperative risk or morbidity. Level of Evidence: 3.