Closure of the Radial Forearm Free Flap Donor Site Defect With a Full-Thickness Skin Graft From the Inner Arm: A Preferred Technique

A Novel design for Local Full-Thickness Skin Graft: Optimizing donor sites of Radial Forearm Free Flap

OBJECTIVE

Donor site deformities remain the primary issues after radial forearm free flap (RFFF) translocations. This study introduced a local full-thickness skin graft (FTSG) from an adjacent cutaneous area to manage RFFF donor sites and evaluated the aesthetic and functional outcomes postoperatively.

PATIENTS AND METHODS

This was a retrospective study among patients undergoing ablative surgery for head and neck tumors followed by defect reconstruction using a RFFF. The RFFF donor site defects were covered by local FTSGs from the adjacent skins whose harvesting was assisted by a forearm model or traditional FTSGs from abdomen. The color matching degree, surgical scars, ranges of wrist movement, and grip strengths in donor forearms were assessed in two groups at twelve months after surgery.

RESULTS

Patients undergoing local FTSGs recovery exhibited better color matching than those repaired by traditional FTSGs from the abdomen. In forearm model, the local FTSGs width should be less than 22% of the forearm circumference located 5 cm away from the center of Fossia cubitalis. All the local FTSGs transplanted with this technique showed primary or secondary healing.

CONCLUSIONS

This study demonstrated using this innovatively designed local FTSGs to close RFFF donor sites was more advantageous than traditional methods.

Closure of radial forearm free flap donor-site defect with proportional local full-thickness skin graft: case series study of a new design

Objectives

The aim of this study was to describe a simple, convenient, and reliable new technique using local full-thickness skin graft (FTSG) for skin coverage of a donor-site defect of the radial forearm free flap (RFFF).

Patients and Methods Between April 2016 and April 2021, five patients with oral squamous cell carcinoma underwent mass resection combined with RFFF reconstruction. After RFFF harvesting, donor-site defects were restored by proportional local FTSG.

Results

The donor-site defects ranged in size from 24 to 41.25 cm2, with a mean of 33.05 cm2. Good or acceptable esthetic outcomes were obtained in all five patients. There was no dehiscence, skin necrosis, wound infection, or severe scarring at the graft site through the end of the postoperative follow-up period, and no patient had any specific functional complaint.

Conclusion

The proportional local FTSG showed promising results for skin coverage of the donor-site defect of the RFFF. This technique could decrease the need for skin grafts from other sites.

Reconstructing Forearm Free Flap Donor Sites Using Full-Thickness Skin Grafts Harvested from the Ipsilateral Arm

Objective

To compare morbidity and aesthetic outcomes of full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs) in the reconstruction of the forearm free flap donor site.

Study Design

Case series, retrospective chart review.

Setting

Institutional microvascular database.

Subjects and Methods

Subjects who underwent forearm free flaps and FTSGs for donor site reconstruction from April 2016 to November 2017 were included. FTSGs were obtained from the donor forearm with a proximal S-shaped incision, thereby avoiding additional wound creation. Morbidity outcomes were compared to 68 consecutive patients with STSG reconstruction from January 2009 to May 2010. Complications, including tendon exposure, subjective functional impairment, complete graft loss, partial graft loss, infection, paresthesias, and hematoma/seroma, were evaluated, as were aesthetic outcomes.

Results

Sixty-eight patients underwent FTSG reconstruction. No significant differences between FTSGs and STSGs were demonstrated in terms of graft loss ≥40% (4% vs 4%, P = 1.000), partial graft loss (<40%) (29% vs 40%, P = .207), tendon exposure (9% vs 12%, P = .573), infection (15% vs 13%, P = .805), paresthesias (12% vs 7%, P = .382), subjective functional impairment (0% vs 2%, P = .316), or hematoma/seroma (2% vs 0%, P = .316). Aesthetic outcomes were better in the FTSG group compared to the STSG group, as determined by both patients ( P = .004) and surgeon ( P < .001).

Conclusions

Our results advocate for the consideration of FTSGs in the reconstruction of the forearm free flap donor site given superior aesthetic results without additional donor site morbidity or additional wound creation when compared to STSGs.

Osseocutaneous radial forearm flap with beavertail modification; a case report of a novel, single, reconstructive free flap for the tongue, floor of mouth and mandible

INTRODUCTION

Complex hard and soft tissue defects produced as a result of ablative resection of head and neck malignancy can represent a reconstructive challenge, especially when patients are medically compromised.

PRESENTATION OF CASE

We present the case of 72-year-old women presenting with an oral squamous cell carcinoma of the right floor of mouth invading the right mandible. Surgical management of the disease required ablative surgery with complex free tissue transfer reconstruction to provide restoration of form and function. Potential reconstructive options were limited by her medical comorbidities and poor vessel patency in the lower limbs, requiring novel thinking and adaptation of established techniques.

DISCUSSION

We describe the first reported use of an osseofasciocutaneous radial forearm flap with a 'beavertail modification' to provide a single and combined reconstructive option to reconstruct a complex hard and soft tissue defect.

CONCLUSION

This novel free-flap technique adds to the reconstructive armamentarium of the head and neck surgeon.