The challenge of composite graft: the use of fluorescent light energy to improve engraftment.

Abstract

Composite graft is a useful tool for the reconstruction of specific facial aesthetic subunits with a single surgical stage. This technique, when successful, gives optimal results in the reconstruction of small defects of nose, ear, eyelid and lips. The aim of this work is to optimize the attachment of composite grafts in the reconstruction of small complex facial defects by combining it with Fluorescent Light Energy (FLE) during the healing process of the graft. The beneficial effects of photobiomodulation (PBM) on wound healing might be attributed to anti-inflammatory signaling, cell proliferation, protein synthesis, and decreased bacterial infection. We previously experienced rewarding achievements using Photonic energy in the treatment of burns, non-healing wounds and pathological scars. Therefore, we chose to exploit the potential of bioluminescent energy to maximize aesthetical and functional results, enhancing the formation of new vascular connections and modulating both inflammatory and scarring processes. From the 2nd postoperative day, the patients were locally treated with 5 FLE sessions every (48/72 h) 2 or 3 days. We evaluated results in terms of time for engraftment, quality of the scarring, infective complications and morbidity of the donor site. Graft survival is subject to many factors, both local and systemic. To overcome these issues, various methods have been studied and described. We here report the successful reconstruction of full-thickness defects of the free margin of the nasal alar rim and the central portion of the inferior lip with a composite graft. These results were highly encouraging if compared with the literature. By analyzing our small cohort, we demonstrated how new technologies may push this traditional reconstructive procedure beyond their old boundaries: overcoming an increased size demand or a potential infective wound environment.