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Original Investigation
Jan/Feb 2017

Dermatography (Medical Tattooing) for Scars and Skin Grafts in Head and Neck Patients to Improve Appearance and Quality of Life

Author Affiliations
  • 1Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam
  • 2Center for Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Diakonessen Hospital, Utrecht, the Netherlands
  • 3Department of Dermatology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam
  • 4Department of Biometrics, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam
JAMA Facial Plast Surg. 2017;19(1):16-22. doi:10.1001/jamafacial.2016.1084
Key Points

Question  What is the effect of scar and skin graft dermatography in the head and neck area on patient satisfaction and quality of life?

Findings  In a case series of 56 patients, the mean improvement in scar or skin graft perception on a visual analog scale (score range, 0-10) was 4 points. All answers to patient satisfaction and quality-of-life questions in 2 modified questionnaires improved significantly.

Meaning  Dermatography is an effectual adjuvant procedure to improve the subjective perception of scar and skin graft appearance and the quality of life in head and neck patients.

Abstract

Importance  Dermatography (medical tattooing) is often overlooked as an adjuvant procedure to improve color mismatch in the head and neck area, and its effect on patient satisfaction and quality of life has not been evaluated, to our knowledge.

Objective  To analyze the effect of dermatography on the subjective perception of the appearance of scars and skin grafts and the quality of life in head and neck patients.

Design, Setting, and Participants  Case series of patients undergoing dermatography at the Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, between July 1, 2007, and April 1, 2015. Participants were invited to respond to 2 questionnaires measuring their scar or graft appearance and their quality of life before and after dermatography as an adjuvant treatment for benign or malignant head and neck tumors.

Intervention  Use of dermatography.

Main Outcomes and Measures  Two questionnaires evaluating a visual analog scale score (range, 0-10) and multiple questions on a 5-point scale focusing on satisfaction with the appearance and the quality of life.

Results  Among 76 patients, 56 (74%) were included in the study. The mean (SD) age of the study cohort was 56.5 (16.0) years, and 42 (75%) were female. The mean improvement in scar or skin graft perception on the visual analog scale of the modified Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty before and after dermatography was 4 points. On the modified Patient Scar Assessment Questionnaire, uniform improvement of approximately 1 point across 9 questions was observed. The answers to all patient satisfaction and quality-of-life questions on both questionnaires improved significantly after dermatography.

Conclusions and Relevance  Dermatography is an effectual adjuvant procedure to improve the subjective perception of scar and skin graft appearance and the quality of life in head and neck patients.

Level of Evidence  4.

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