Objective Measurement of Skin Color Matching in Flap Reconstructive Surgery: A Systematic Review.

Background: Flap reconstruction outcomes can be compromised by color mismatch between transferred tissue and the recipient site, potentially causing patient distress. This systematic review comprehensively evaluated color matching in flaps across various anatomical regions and donor sites. Methods: A systematic search of MEDLINE and Embase was conducted from their inception to May 24, 2024 to identify studies addressing color matching in flaps. A narrative analysis was performed to synthesize the findings, focusing on 3 main categories: head and neck, breast, and extremities. The studies were assessed for risk of bias using the Joanna Briggs Institute appraisal tool. Results: Out of 649 screened articles, 11 studies met the inclusion criteria, including 7 on the head and neck, 3 on the breast, and 1 on the extremities. All studies were assessed to have a low to moderate risk of bias. The L*a*b* system was the primary method for assessing color match. Radial forearm flaps in the head and neck region demonstrated superior color matching, whereas anterolateral thigh and fibula flaps showed greater mismatches. Ethnicity plays a significant role in determining skin color match. Radiation therapy and temporal changes contributed to improved outcomes. Color match in breast and extremity reconstructions has been less explored than in head and neck reconstructions. Conclusions: The studies emphasize a focus on head and neck reconstructions in color match research, highlighting significant gaps in other anatomical areas. Future research should prioritize patient involvement and the integration of large-scale national databases to better address aesthetic and psychological outcomes.