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Mosquera C, Weyh A, Malik M, Fernandes R, Bunnell A, Nedrud S. Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: A systematic review. Microsurgery 2024; 44:e31126. [PMID: 37990820 DOI: 10.1002/micr.31126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Radial forearm free flap (RFFF) donor site closure is traditionally performed with split thickness skin grafts (STSG), which can be associated with poor aesthetics, wrist stiffness, paresthesia, reduced strength, and tendon exposure. Full thickness skin grafts (FTSG) are potentially beneficial as they provide a more durable coverage, and the skin graft donor site can be closed primarily, which is more aesthetic. The aim of this systematic review is to compare the outcomes of STSG versus FTSG for closure of the RFFF donor site. METHODS A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary objective was to answer: do subjects undergoing RFFF harvest, utilizing FTSG to close the RFFF donor site, compared to STSG, achieve superior aesthetics at the RFFF donor site? Included papers compared FTSG and STSG with statistical data. Means were compared with t-test and proportions with Fisher's exact test. RESULTS The initial search resulted in 1851 studies. After applying the inclusion/exclusion criteria, the search resulted in eight studies, with 366 total skin grafts, 197 STSG and 169 FTSG. Six studies evaluated aesthetics utilizing a Likert scale, with the scaled average aesthetic score for FTSG being 7.9/10 compared to 6.9/10 for STSG (p < .001). Tendon exposure was measured in five studies, with a rate of 13.1% for STSG versus 10.6% for FTSG (p = .555). No significant difference in function was observed, however, methods to quantify function were heterogeneous. CONCLUSION FTSG compared to STSG, resulted in statistically significant improved aesthetics, with comparable rates of tendon exposure and function.
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Affiliation(s)
- Camilo Mosquera
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Michael Malik
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Anthony Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Stacey Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Private Practice, Jacksonville, FL, USA
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Quadri P, McMullen C. Oral Cavity Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00048-8. [PMID: 37164898 DOI: 10.1016/j.otc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the appropriate options for reconstruction of those defects are delineated.
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Affiliation(s)
- Pablo Quadri
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA.
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Reducing morbidity in radial forearm free flap donor site: a review of closure techniques. Curr Opin Otolaryngol Head Neck Surg 2022; 30:363-367. [PMID: 36004786 DOI: 10.1097/moo.0000000000000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Radial forearm free tissue transfer (RFFF) has been an extremely reliable reconstructive option for head and neck oncologic defects for over 30 years. With high reliability, interest has shifted in minimizing donor site morbidity, much of which results from closure techniques. RECENT FINDINGS Portable negative pressure wound devices, newer dermal substitutes, and local flap techniques have improved donor site aesthetics and function. SUMMARY Outcomes of the RFFF donor site may benefit from newer techniques in closure.
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Vahldieck M, Zyba V, Hartwig S, Paßmann B, Scheer M. Retrospective comparison of split-thickness skin graft versus local full-thickness skin graft coverage of radial forearm free flap donor site. J Craniomaxillofac Surg 2022; 50:664-670. [DOI: 10.1016/j.jcms.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022] Open
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Bi AS, Fisher ND, Konda SR, Egol KA, Ganta A. Delayed Versus Primary Closure of Diaphyseal Forearm Fractures in Adults: Short-Term Soft Tissue Outcomes. Indian J Orthop 2022; 56:1594-1600. [PMID: 36052385 PMCID: PMC9385914 DOI: 10.1007/s43465-022-00688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the effect of delayed closures, whether delayed primary closure (DPC) or split-thickness skin grafting (STSG), of operatively treated forearm fractures on short-term soft tissue outcomes. METHODS In this retrospective cohort comparative study of two academic-level one trauma centers from 2010 to 2020, adult patients with diaphyseal forearm fractures who underwent open reduction and internal fixation (ORIF) were either closed primarily at index surgery, or underwent delayed closure, either with DPC or with a STSG. Primary outcome measures were soft-tissue outcomes as measured by wound healing (delayed healing, dehiscence, or skin breakdown) and fracture-related infection (FRI) at time of final follow-up. RESULTS Eighty-one patients with 81 diaphyseal forearm fractures underwent ORIF with a mean follow-up of 14.3 months. Forty-one fractures (50.6%) were open injuries. Thirteen patients (16.0%) were unable to be closed primarily and underwent an average of 2.46 ± 0.7 surgeries including final coverage, with an average of 4.31 ± 2.8 days to final coverage. Four patients (30.8%) underwent DPC and 9 (69.2%) underwent STSG. Five (6.6%) patients in the delayed closure group had pre-operative compartment syndrome and underwent formal two-incision fasciotomies. There were no significant differences between delayed versus primary closure in wound healing complication rates, FRI, or radiographic union. CONCLUSIONS Diaphyseal forearm fractures that undergo ORIF have equivalent short-term soft tissue outcomes when closed primarily at index surgery or when closed in a delayed fashion.
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Affiliation(s)
- Andrew S. Bi
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA
| | - Nina D. Fisher
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA
| | - Sanjit R. Konda
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA ,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Espy, Richmond Hill, NY 11418 USA
| | | | - Abhishek Ganta
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA ,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Espy, Richmond Hill, NY 11418 USA
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Long-Term Donor Site Morbidity and Flap Perfusion Following Radial versus Ulnar Forearm Free Flap—A Randomized Controlled Prospective Clinical Trial. J Clin Med 2022; 11:jcm11133601. [PMID: 35806884 PMCID: PMC9267742 DOI: 10.3390/jcm11133601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022] Open
Abstract
This clinical prospective randomized controlled study aimed to investigate the differences between Radial (RFFF) and Ulnar (UFFF) Forearm Free Flap in terms of success, performance, and donor site morbidity. Thirty patients with reconstruction of the head and neck region were included. For the first time, this study assessed flap-perfusion characteristics, donor-site-wound-healing dynamics and hand perfusion using hyperspectral imaging. Further, subjective (Likert-scale, DASH-score) and objective (grip/pinch-strength) parameters of donor site morbidity were analysed. Postoperative follow-up was performed until 6 months after index surgery. With 100% of patients, RFFF and UFFF were equally successful. Compared to surrounding reference, UFFF revealed significant lower tissue oxygenation saturation (StO2) than RFFF. Compared with UFFF, blood flow in both the thenar and hypothenar region were significantly reduced 6 months following RFFF transfer. After four weeks, 27% more patients demonstrated impaired wound healing following RFFF transfer. After 6 months, epithelial-surface continuity was restored in all patients of both groups. After 6 months, overall rates of both subjective and objective donor site morbidity were comparable between RFFF and UFFF. RFFF and UFFF both demonstrate similar success rates and HSI-perfusion dynamics following transfer. After 4 weeks, wound-healing disorder appeared significantly more often in RFFF than in UFFF; however, they became equal after 6 months. RFFF and UFFF can be considered as mutual alternatives.
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De Cicco D, Tartaro G, Ciardiello F, Fasano M, Rauso R, Fiore F, Spuntarelli C, Troiano A, Lo Giudice G, Colella G. Health-Related Quality of Life in Oral Cancer Patients: Scoping Review and Critical Appraisal of Investigated Determinants. Cancers (Basel) 2021; 13:cancers13174398. [PMID: 34503208 PMCID: PMC8431462 DOI: 10.3390/cancers13174398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Oral cancer may strongly impair patients’ quality of life. Huge efforts have been made during recent decades in trying to improve the treatment outcomes in terms of patients’ survival, self-perception, and satisfaction. Consequently, the investigation into health-related quality of life (HRQOL) became an established and worldwide practice. Hundreds of studies tried to clarify which could be the most important variables that impact HRQOL in head and neck cancer patients. However, such a complex topic may be influenced by a multitude of interconnected aspects and several controversies were reported. In this study the current literature was reviewed to identify all those possible sources of bias that may be encountered in trying to correlate HRQOL to patient-specific or disease/treatment-specific aspects. As a result, a list of recommendations was reported to enhance the evidence of future studies. Abstract Background: health-related quality of life (HRQOL) represents a secondary endpoint of medical interventions in oncological patients. Our aim was to highlight potential sources of bias that could be encountered when evaluating HRQOL in oral cancer patients. Methods: this review followed PRISMA-ScR recommendations. Participants: patients treated for oral cancer. Concept: HRQOL assessed by EORTC QLQ-C30 and QLQ-H&N35/QLQ-H&N43. A critical appraisal of included studies was performed to evaluate the accuracy of data stratification with respect to HRQOL determinants. Results: overall, 30 studies met the inclusion criteria, totaling 1833 patients. In total, 8 sociodemographic (SDG) and 15 disease/treatment-specific (DT) HRQOL determinants (independent variables) were identified. The mean number of the independent variables was 6.1 (SD, 4.3)—5.0 (SD, 4.0) DT-related and 1.1 (SD, 1.8) SDG-related variables per article. None of the included papers considered all the identified determinants simultaneously. Conclusions: a substantial lack of evidence regarding HRQOL determinants was demonstrated. This strongly weakens the reliability of the reported findings due to the challenging presence of baseline confounding, selection, and omitted variable biases. The proposed approach recommends the use of further evaluation tools that gather more variables in a single score together with a selection of more homogeneous, reproducible, and comparable cohorts based on the identified baseline confounding.
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Affiliation(s)
- Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Gianpaolo Tartaro
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.C.); (M.F.)
| | - Morena Fasano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.C.); (M.F.)
| | - Raffaele Rauso
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
| | - Francesca Fiore
- Department of Internal and Polyspecialist Medicine, A.O.U. “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Chiara Spuntarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Antonio Troiano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
- Correspondence:
| | - Giorgio Lo Giudice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Giuseppe Colella
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
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Shimada K, Ojima Y, Ida Y, Komiya T, Matsumura H. Negative-pressure wound therapy for donor-site closure in radial forearm free flap: A systematic review and meta-analysis. Int Wound J 2021; 19:316-325. [PMID: 34101358 PMCID: PMC8762548 DOI: 10.1111/iwj.13632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
Negative‐pressure wound therapy (NPWT) is often used for skin graft site dressing, and several studies have reported that its use improves skin graft failure in the forearm flap donor site. The present systematic review aimed to evaluate the efficacy of NPWT with skin graft for donor‐site closure in radial forearm free flap (RFFF) reconstruction. A systematic search in PubMed, Web of Science, and Cochrane Library databases was conducted. The search terms used for PubMed were ([radial forearm]) AND ([donor]) AND ([negative pressure or vacuum]). This review was registered in the International Prospective Register of Systematic Reviews and performed in accordance with the preferred reporting items for systematic reviews and meta‐analyses statement. Three prospective randomised controlled trials and three retrospective comparative studies were included. Compared with conventional bolster dressing, the use of NPWT dressing did not lead to significant improvements in partial skin graft loss, tendon exposure, and other complications. NPWT improved hand functionality earlier; nonetheless, the cost of the device and dressings was a disadvantage. The use of NPWT for skin graft fixation in the RFFF donor site is not generally recommended.
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Affiliation(s)
- Kazuki Shimada
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yosuke Ojima
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yukiko Ida
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takako Komiya
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
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Di Giuli R, Dicorato P, Kaciulyte J, Marinari N, Conversi F, Mazzocchi M. Donor Site Wound Healing in Radial Forearm Flap: A Comparative Study Between Dermal Substitute and Split-Thickness Skin Graft Versus Full-Thickness Skin Graft Primary Coverage. Ann Plast Surg 2021; 86:655-660. [PMID: 33661229 DOI: 10.1097/sap.0000000000002777] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Radial forearm flap (RFF) is one of the most used flaps in reconstructive surgery. Despite its versatility and effectiveness, the donor site is affected by aesthetic and functional issues. In the group of techniques described to improve the donor site morbidity, dermal substitutes offer a valid approach in the wound management. A bilayered bioresorbable dermal substitute (Hyalomatrix) was used to provide the primary coverage of the RFF harvest site followed after 3 weeks by a split-thickness skin graft placement. In this study, 37 patients underwent RFF donor site reconstruction and subjected to a minimum follow-up of 1 year. The dermal substitute was applied on 15 patients, and their outcomes were compared with the data achieved by 22 patients submitted to immediate reconstruction with autologous full-thickness skin graft. Results were documented by digital photographs, the visual analog scale, the Vancouver Scar Scale, and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Data were analyzed and compared through statistical analysis. Total wound coverage was achieved in 4 to 6 weeks, and no tendon impairments were reported in the dermal substitute group. In our experience, the use of the dermal substitute is a valuable mean to minimize RFF donor site morbidity with excellent functional and aesthetic outcomes.
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Affiliation(s)
- Riccardo Di Giuli
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Paolo Dicorato
- Unit of Plastic and Reconstructive Surgery, Department of Surgery "P.Valdoni," Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | | | - Niccolò Marinari
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Francesco Conversi
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Marco Mazzocchi
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
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Hunger S, Krennmair S, Stehrer R, Postl L, Brandner A, Malek M. Closure of the radial forearm free flap donor site with split-thickness skin graft or amniotic membrane: A prospective randomized clinical study. J Craniomaxillofac Surg 2021; 49:403-414. [PMID: 33741237 DOI: 10.1016/j.jcms.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 11/12/2020] [Accepted: 02/15/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to compare the clinical, aesthetic, and functional outcomes between amniotic membrane (test group) and split-thickness skin grafts (control group) used for radial forearm free flap defect closure. The primary outcome measurement for both groups was assessment of the defect closure healing process. In addition, aesthetic (Vancouver Scar Scale) and functional outcomes (skin sensitivity, hand/wrist functionality, grip strength) were evaluated. Fifty eligible patients with radial forearm free flap donor site defects were randomly assigned to two groups receiving either amniotic membrane (test group; n = 25) or split-thickness skin graft (control group; n = 25) for defect covering. Forty-seven of the 50 patients (n = 47) were able to be followed up for 6 months and showed a significantly longer healing process (p < 0.001) with amniotic membrane (64.5 ± 38.4 days; n = 24) than with split-thickness skin grafts (29.2 ± 8.9 days; n = 23); however, there were no differences in the prevalence of healing defects/dehiscence and/or wound infections. Forty-two of the 47 patients (21 in each group) were able to be continually followed up for 12 months, and showed no differences in terms of clinical outcome as well as the subjective and objective aesthetic and functional results evaluated. With regard to the clinical, aesthetic, and functional outcomes evaluated for radial forearm free flap defects, coverage with amniotic membrane offers an excellent alternative treatment approach, avoiding secondary induced donor site morbidity.
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Affiliation(s)
- Stefan Hunger
- Department of Maxillofacial Surgery, Johannes Kepler University, 4020, Linz, Austria.
| | - Stefan Krennmair
- Department of Maxillofacial Surgery, Johannes Kepler University, 4020, Linz, Austria.
| | - Raphael Stehrer
- Department of Maxillofacial Surgery, Johannes Kepler University, 4020, Linz, Austria.
| | - Lukas Postl
- Department of Maxillofacial Surgery, Johannes Kepler University, 4020, Linz, Austria.
| | - Andreas Brandner
- Department of Maxillofacial Surgery, Johannes Kepler University, 4020, Linz, Austria.
| | - Michael Malek
- Department of Maxillofacial Surgery, Johannes Kepler University, 4020, Linz, Austria.
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Jiang ZY, Yu XT, Liao XC, Liu MZ, Fu ZH, Min DH, Guo GH. Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials. Burns 2021; 47:747-755. [PMID: 33814213 DOI: 10.1016/j.burns.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Although skin grafts are widely used in reconstruction of large skin defect and complex wounds, many factors lead to suboptimal graft take. Negative-pressure wound therapy (NPWT) reportedly increases the graft take rates when added to skin grafting, but a summary analysis of the data of randomized controlled trials has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to compare the effectiveness and safety of NPWT and non-NPWT for patients with skin grafts. METHODS We searched PubMed, Embase, Cochrane Library, and CNKI for relevant trials based on predetermined eligibility criteria from database establishment to February 2020. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heterogeneity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis. RESULTS Ten randomized controlled trials with 488 patients who underwent NPWT or non-NPWT were included. Compared with non-NPWT, NPWT yielded an improved the percentage of graft take, a reduction in days from grafting to discharge, with lower relative risk of re-operation, and no increased relative risk of adverse event. Further, the subgroup analysis showed an improved the percentage of graft take in negative pressure of 80 mmHg, and no improved the percentage of graft take in negative pressure of 125 mmHg. CONCLUSION NPWT is more effective than non-NPWT for the integration of skin grafts, and the negative pressure of 80 mmHg can be recommended. Data on adverse events and negative pressure are, however, limited. A better understanding of complications after NPWT and the ideal negative pressure for the integration of skin grafts is imperative.
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Affiliation(s)
- Zheng-Ying Jiang
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Xiao-Ting Yu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Xin-Cheng Liao
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Ming-Zhuo Liu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Zhong-Hua Fu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Ding-Hong Min
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Guang-Hua Guo
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China.
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Radial Flap in Reconstructions of the Hand - Case Series Study. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2x3.1cm to 9x13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.
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