1
|
Zhang C, Pandya S, Alessandri Bonetti M, Costantino A, Egro FM. Comparison of split thickness skin graft versus full thickness skin graft for radial forearm flap donor site closure: A systematic review and Meta-analysis. Am J Otolaryngol 2024; 45:104156. [PMID: 38142610 DOI: 10.1016/j.amjoto.2023.104156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The radial forearm flap (RFF) is one of the most commonly used flaps in reconstructive surgery. Split-thickness skin grafting (STSG) has traditionally been used for closure of the forearm. However, full-thickness skin grafting (FTSG) has gained in popularity to achieve more satisfactory results. The aim of the study is to identify the best RFF donor site closure technique by comparing the functional and aesthetic outcomes of STSG and FTSG. METHODS PubMed and EMBASE databases were queried. Only studies comparing complications rate, functional and aesthetic outcomes between STSG and FTSG were included. The primary outcome was graft failure rate. Secondary outcomes included the aesthetic result and functionality of the forearm/wrist. RESULTS A total of 13 studies were included in this review, accounting for a total of 712 patients with mean age of 60.7 years. Overall, 348 patients underwent FTSG and 377 underwent STSG. The mean follow-up was 14.7 months. The rate of graft failure in FTSG was significantly higher compared to STSG (OR: 2.79, 95 % CI 1.38-5.65, p = 0.004). There was no significant difference in rate of tendon exposure (OR: 0.83, p = 0.65) and infection (OR: 1.37, p = 0.42). Regarding the aesthetic outcome, no significant difference between FTSG and STSG based on observer (SMD = -0.37, p = 0.17) and patient (SMD = -0.016, p = 0.93) assessment, respectively. Overall postoperative functional assessment showed a not severely impaired hand and arm function in both groups. Subjective evaluation of pain was similar between groups. CONCLUSION FTSG is associated with higher risk of graft failure than STSG in RFF donor site closure, without significant improvement in aesthetic results.
Collapse
Affiliation(s)
- Casey Zhang
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | - Sumaarg Pandya
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | | | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Francesco M Egro
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA.
| |
Collapse
|
2
|
Al-Aroomi MA, Mashrah MA, Al-Worafi NA, Zhou W, Sun C, Pan C. Biomechanical and aesthetic outcomes following radial forearm free flap transfer: comparison of ipsilateral full-thickness skin graft and traditional split-thickness skin graft. Int J Oral Maxillofac Surg 2024; 53:109-116. [PMID: 37244863 DOI: 10.1016/j.ijom.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/29/2023]
Abstract
The radial forearm free flap (RFFF) is associated with donor site morbidity. This study aimed to quantify the functional and aesthetic outcomes after closure of the RFFF donor site using triangular full-thickness skin grafts (FTSGs) harvested adjacent to the flap or traditional split-thickness skin grafts (STSGs). The study included patients who underwent oral cavity reconstruction with an RFFF between March 2017 and August 2021. The patients were divided into two groups based on the donor site closure method: FTSG or STSG. The primary outcomes were biomechanical grip strength, pinch strength, and range of wrist movements. Subjective donor site morbidity, aesthetic and functional results were also analysed. The study included 75 patients (FTSG n = 35; STSG n = 40). Postoperatively, there was a statistically significant difference in grip strength (P = 0.049) and wrist extension (P = 0.047) between the FTSG and STSG groups, in favour of the STSG. Differences between the groups in pinch strength and other wrist motions were not statistically significant. The harvesting time was significantly shorter for the FTSG (P = 0.041) and the appearance of the donor site was better (P = 0.026) when compared to the STSG. Cold intolerance was more frequent in the STSG group (32.5% STSG vs 6.7% FTSG; P = 0.017). Subjective function, numbness, pain, hypertrophic scar, itching, and social stigma did not differ significantly between the groups. Compared with the STSG, the FTSG showed better cosmesis and avoided additional donor sites, with clinically negligible differences in hand biomechanics.
Collapse
Affiliation(s)
- M A Al-Aroomi
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, Liaoning, China.
| | - M A Mashrah
- Department of Implantology, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - N A Al-Worafi
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, China
| | - W Zhou
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, Liaoning, China
| | - C Sun
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, Liaoning, China.
| | - C Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| |
Collapse
|
3
|
Saleki M, Noor MA, Hurt P, Abul A. Full-Thickness Skin Graft Versus Split-Thickness Skin Graft for Radial Forearm Free Flap Transfer in Oral Cavity Reconstruction: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49279. [PMID: 38143661 PMCID: PMC10746958 DOI: 10.7759/cureus.49279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
The radial forearm free flap (RFFF) is a surgical technique for addressing intraoral reconstruction. However, with the limitation of an unavoidable defect at the RFFF donor site, split-thickness skin grafts (STSGs) have been a solution for repairing these defects, but they are not without challenges. This study aimed to evaluate an approach using full-thickness skin grafts (FTSGs), comparing their effectiveness in terms of aesthetics, pain, complications, and scarring. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing FTSG with STSG for RFFF donor site repair in head and neck cancer patients were included. Primary outcomes measured were appearance and pain at the RFFF site, and secondary outcomes were infection, tendon exposure, graft loss, and scar assessment. A meta-analysis and systematic review of eight studies demonstrated that FTSG provided a superior aesthetic appearance at the RFFF donor site compared to STSG (p = 0.001), with low heterogeneity among the studies. The analysis found no significant difference in donor site pain between techniques. There were no significant differences in infection, tendon exposure, or skin graft loss between the two graft methods. This study suggests that FTSG is comparable to STSG in terms of donor site pain, scarring, and infection while offering superior aesthetic outcomes.
Collapse
Affiliation(s)
| | | | - Patrick Hurt
- Medicine & Surgery, Barts and The London School of Medicine, London, GBR
| | - Ahmad Abul
- Medicine, University of Leeds, Leeds, GBR
| |
Collapse
|
4
|
Benjamin T, Zebolsky AL, Haddad AF, Ochoa E, Plonowska-Hirschfeld KA, Park AM, Seth R, Knott PD. Anterolateral Thigh Free Flap Versus Thigh Split Thickness Skin Graft: Comparison of Morbidity in the First 30 Days. Facial Plast Surg Aesthet Med 2023; 25:108-112. [PMID: 36201233 DOI: 10.1089/fpsam.2022.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Background: An anterior thigh split thickness skin graft (AT-STSG) is frequently needed to close the radial forearm free flap (RFFF) donor site, conferring morbidity to two extremities. The anterolateral thigh (ALT) free flap is virtually always closed primarily. Objective: To compare donor site pain, sensation, motor function, and cosmesis associated with the AT-STSG and the ALT. Methods: Patients undergoing an ALT or an RFFF with AT-STSG were enrolled in a prospective observational cohort study. Pain, tingling, numbness, lower extremity function, and subjective donor site cosmetic satisfaction were measured at 1 week and 1 month postoperation using validated instruments. Results: Forty-eight patients were included, with a mean age of 64.2 years (female 31.2%). There were no differences in age or medical comorbidities between the two groups. The average donor defect was 50 and 180 cm2 for the AT-STSG and ALT cohorts, respectively. At 1 week and 1 month postoperatively, we did not detect a difference in donor site pain, pruritus, numbness or tingling, lower extremity function, or subjective cosmetic satisfaction between the two cohorts. Conclusion: ALT primary donor site morbidity, including pain, sensory function, motor function, and cosmesis, is equivalent to RFFF secondary donor site morbidity at 1 week and 1 month postoperatively.
Collapse
Affiliation(s)
- Tania Benjamin
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Aaron L Zebolsky
- Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Edgar Ochoa
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Karolina A Plonowska-Hirschfeld
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Andrea M Park
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - P Daniel Knott
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
5
|
Burger A, Kiehlmann M, Gruenherz L, Gousopoulos E, Sohn M, Lindenblatt N, Giovanoli P, Rieger UM. Donor Site Defect Coverage of the Forearm with Dermal Substitute After Harvesting Radial Forearm Free Flap for Phalloplasty: Is MatriDerm® Worth the Effort? Indian J Surg 2023. [DOI: 10.1007/s12262-023-03705-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
AbstractAn aesthetically and functionally pleasing phalloplasty is most commonly performed by a free radial forearm flap. However, the problem with donor site morbidity on the forearm remains unsolved. The aim of this study was to evaluate if the use of a dermal template such as MatriDerm® on the donor site significantly decreases the incidence of complications based on the Clavien–Dindo classification, such as wound healing disorders and reoperation rate, and if it could shortens the duration of hospital stay. A case series analysis was conducted at our institution. A total of 21 patients divided into two groups undergoing the phallic construction after the Gottlieb and Levine design in a single center underwent the donor site defect coverage either by MatriDerm® and split-thickness skin graft from the thigh or by full-thickness skin graft from the groin area. The use of MatriDerm® and split-thickness skin graft showed to have a statistically significant impact on the rate of complications (p = 0.008). Complications that were treated conservatively as well as that require surgical revision were significantly lower in the MatriDerm® group than in the full-thickness skin graft group (p = 0.002). Complications occurred not only at the forearm but also at the groin, where the full-thickness skin graft was harvested. The large dimension of the free radial forearm flap used for phalloplasty resulted in a significant donor site morbidity, leading to wound healing disorders, reoperations, and extended length of hospital stay. Therefore, we consider the use of dermal templates such as MatriDerm® as worth the additional effort and costs in this patient collective.
Collapse
|
6
|
Hughes KR, Fong A, Rozen WM, Leong JCS. The arterialised saphenous venous flow-through flap for managing the radial forearm free flap donor site. Microsurgery 2022; 42:333-340. [PMID: 35297112 PMCID: PMC9315149 DOI: 10.1002/micr.30883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. METHOD A cohort study of six patients (five male, one female; mean age 59 [range 19-90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra-flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. RESULTS In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6-15 cm (mean 11.5 cm) and widths of 4-6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24-90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow-up of 6 months (4-24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. CONCLUSION The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.
Collapse
Affiliation(s)
- Kimberley R Hughes
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Alisha Fong
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Warren M Rozen
- Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - James C S Leong
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
7
|
Bruin LL, Hundepool CA, Duraku LS, Mureau MAM, Zuidam JM. Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review. J Plast Reconstr Aesthet Surg 2021; 75:1-9. [PMID: 34736849 DOI: 10.1016/j.bjps.2021.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. METHODS A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. RESULTS Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. CONCLUSION The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should therefore focus on the prognostic factors and preventive measures of neuropathic pain to further improve clinical outcomes of this widely used flap.
Collapse
Affiliation(s)
- L L Bruin
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C A Hundepool
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L S Duraku
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M A M Mureau
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J M Zuidam
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
8
|
Objective and Subjective Comparisons of Split Thickness Skin Graft and Full Thickness Skin Graft for Radial Forearm Flap Donor Sites Using a New Measuring Method. J Craniofac Surg 2021; 32:e594-e598. [PMID: 34054091 DOI: 10.1097/scs.0000000000007820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
ABSTRACT A split thickness skin graft (STSG) or a full thickness skin graft (FTSG) are commonly used for donor site closure after raising a radial forearm flap. The aesthetic outcome of the donor site is frequently not satisfying for the patient. This study evaluated the aesthetic outcome of the donor site of a radial forearm flap covered with an STSG or FTSG using an objective measurement method. The forearms of 30 patients (15 FTSG, 15 STSG) were scanned with an optical three-dimensional scanner. The surface of the forearm at the skin transplant was cut out and filled by an automatic hole-filling algorithm. The mean surface deviation between the original and the filled forearm was acquired. This method was validated with a control group of 15 volunteers. A questionnaire investigating aesthetical and healing satisfaction, postoperative pain and scarring was filled in by the patients. The mean surface difference in the STSG group was 0.9907 ± 0.3120 and 0.6177 ± 0.2245 mm in the FTSG group. The difference in the surface deviation between STSG and FTSG groups was significant (P = 0.0009). Correlations between the surface deviation and the subjective aesthetical satisfaction of the patient were not significant. In the questionnaires no significant differences between STSG and FTSG group were measured. Both FTSGs and STSGs resulted in good aesthetical outcomes after closure of a radial forearm flap donor site. Scanning the radial forearm flap donor site with an optical three-dimensional scanner supplied an objective, fast, and reliable measuring method of aesthetical outcomes.
Collapse
|
9
|
Abbate V, Iaconetta G, Sani L, Bonavolontà P, Di Lauro AE, Masone S, Califano L, Orabona GDA. The Use of Dermal Substitutes for Donor Site Closure After Radial Forearm Free Flap Harvesting. J Craniofac Surg 2021; 32:e205-e208. [PMID: 33705075 DOI: 10.1097/scs.0000000000006808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of our study was to analyze the aesthetic and functional outcome in the radial forearm free flap donor site using a simple split thickness skin grafting (STSG) closure compared with the use of dermal scaffold supporting the STSG closure. METHODS The study analyzed 18 patients, divided in 2 groups based on the donor site closure modality. In STSG group, a simple STSG was used to cover the defect. In the DS + STSG group, the defect was covered by the use of dermal substitute (MatriDerm) supporting the STSG. Groups were compared on the following outcome variable: scar status; hand function; circumferences at most proximal and most distal point of the graft. All patients were followed up 1, 6, and 12 months post-operative. RESULTS Nine patients from STSG group showed a difference in circumference between the operated and contralateral limbs respectively of 2.9 mm proximal and 1.2 mm distal; in the 9 patients of DS + STGS group the difference was respectively of 1.2 mm proximal and 1.3 mm distal. Welch unequal variances t-test demonstrated statistical significance of the values with P < 0.004 (P < 0.5). The average VSS was 1.82 ± 0.2 for STSG group and 1.75 ± 0.2 for DS + STGS group. The DASH score was 21.8% in STSG group and 19.4% in DS + STGS group. CONCLUSION Our study shows that patients treated with Matriderm + STSG obtained a better result both in esthetic and functional outcomes.
Collapse
Affiliation(s)
- Vincenzo Abbate
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | | | - Lorenzo Sani
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | - Paola Bonavolontà
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | - Alessandro E Di Lauro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II;"
| | - Stefania Masone
- University of Naples "Federico II", Department of Clinical Medicine and Surgery, General Surgery Unit, Naples, Italy
| | - Luigi Califano
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | - Giovanni D A Orabona
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Shimbo K, Okuhara Y, Yokota K. The use of ipsilateral skin grafts or local flaps for the closure of a free radial forearm flap donor site: a systematic review. J Plast Surg Hand Surg 2021; 55:261-267. [PMID: 33586608 DOI: 10.1080/2000656x.2021.1883631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Skin grafts from distant sites are typically used to close free radial forearm flap (FRFF) donor sites. However, a variety of closure methods have been reported that avoid a second donor site. These are divided into four groups: separately combined full-thickness skin graft (FTSG), FTSG method based on V-Y closure, perforator flap, and non-perforator flap. We aimed to assess the differences in outcomes, including adapted FRFF size and postoperative complications, among the four groups of closure methods used for FRFF defects. Applying the Preferred Reporting Items for the PRISMA protocol systematic reviews and meta-analysis, the PubMed and MEDLINE medical databases were searched from inception to September 2020 to identify articles about closure using an ipsilateral FTSG or local flap of the FRFF donor site. Study characteristics, FRFF size, complication rates were extracted for analysis. Twenty-four studies were included for analysis. The FTSG method based on V-Y closure was the most widely used and could be adapted to the largest and more variable FRFF sizes. The short-term complications rate was lowest for the FTSG method based on V-Y closure and the highest for the perforator flap method. The FTSG method based on V-Y closure was considered to be the most convenient and reliable. However, FRFF size should be restricted to ≤60 cm2, and the non-perforator flap can be a good choice if FRFF is <35 cm2.
Collapse
Affiliation(s)
- Keisuke Shimbo
- Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yukako Okuhara
- Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazunori Yokota
- Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
12
|
Radial forearm free flap in head and neck cancer treatment: may dermal substitutes have a role in minimizing the donor site morbidity? EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Krane NA, Mowery A, Azzi J, Petrisor D, Wax MK. Reconstructing Forearm Free Flap Donor Sites Using Full-Thickness Skin Grafts Harvested from the Ipsilateral Arm. Otolaryngol Head Neck Surg 2020; 162:277-282. [DOI: 10.1177/0194599819901124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Natalie A. Krane
- Department of Otolaryngology–Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alia Mowery
- Department of Otolaryngology–Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - James Azzi
- The Palm Beach Center for Facial Plastic and Laser Surgery, Palm City, Florida, USA
| | - Daniel Petrisor
- Department of Oral and Maxillofacial Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark K. Wax
- Department of Otolaryngology–Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
14
|
Halama D, Dreilich R, Lethaus B, Bartella A, Pausch NC. Donor-site morbidity after harvesting of radial forearm free flaps—comparison of vacuum-assisted closure with conventional wound care: A randomized controlled trial. J Craniomaxillofac Surg 2019; 47:1980-1985. [DOI: 10.1016/j.jcms.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/01/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022] Open
|
15
|
Use of amniotic membrane for radial forearm free flap donor site coverage: clinical, functional and cosmetic outcomes. Clin Oral Investig 2019; 24:2433-2443. [DOI: 10.1007/s00784-019-03104-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/30/2019] [Indexed: 01/31/2023]
Abstract
Abstract
Objective
To evaluate the clinical, functional and aesthetic outcomes for radial forearm free flap (RFFF) donor sites covered with amniotic membrane (AM).
Material and methods
The healing process of patients with RFFF donor sites covered with AM was prospectively followed for 1 year. Additionally at the 12-month evaluation, objective scoring systems were used to assess the aesthetic (Vancouver scar scale, VSS: range 1–13) and functional outcome (skin sensibility, hand/wrist functionality [goniometer], grip strength [score 1 = excellent, 5 = poor]). By using a subjective rating system (score 1 = excellent, 5 = poor), the patient-reported aesthetic and functionality outcome was correlated with objective data analysis.
Results
Twenty-one out of 23 patients were followed for 12 months (dropout: 2 patients at 3 months). In 17/23 (73.9%) patients RFFF defect covered with AM showed an uneventful healing period (< 3 months). Prolonged healing periods (> 3 months < 6) for 6 patients (26.1%) were attributed to wound infections (4×), seroma (1×) and inflammation (1×). At the 1-year evaluation, there was a significant (p < 0.01) correlation between subjective (2.0 ± 0.71) and objective aesthetic scores (VVS 3.74 ± 2.18), and a successful grip strength (score 1.67 ± 0.86); however, thumb hyposensibility in 76.2% was seen. A high body mass index (BMI) was in conjunction with a negative (p = 0.012) and the use of antihypertensive medications provided positive effects (p = 0.041) on the aesthetic outcome.
Conclusion
RFFF donor site defects covered using AM show excellent clinical, aesthetic and functional outcome representing patient comorbidities (BMI, antihypertensive drugs) might affect the aesthetic outcome.
Clinical relevance
In relation to the excellent outcomes found, the use of AM offers an alternative treatment procedure for RFFF defect covering.
Collapse
|
16
|
Pirlich M, Horn IS, Mozet C, Pirlich M, Dietz A, Fischer M. Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques. Eur Arch Otorhinolaryngol 2018; 275:1219-1225. [DOI: 10.1007/s00405-018-4908-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/19/2018] [Indexed: 12/01/2022]
|
17
|
Abstract
PURPOSE OF REVIEW Fasciocutaneous and osteocutaneous free flap reconstruction has significantly changed the way surgeons reconstruct defects following ablation of head and neck tumors. Over time, success rates of free flaps have approached 98%, allowing surgeons to shift their focus to minimizing morbidities associated with the donor sites. The radial forearm, anterolateral thigh, and fibula free flaps are the three most commonly used flaps in head and neck reconstruction, and therefore each of their advantages and associated morbidities are of particular interest. The present article aims to review the morbidities associated with each of the commonly used head and neck free flaps and techniques to minimize them that are described in the most recent literature. RECENT FINDINGS New techniques such as negative-pressure wound therapy, full thickness grafts, and rotational flaps have been developed recently that minimize these morbidities. SUMMARY The techniques described in the current review may improve long-term patient outcomes both esthetically and functionally.
Collapse
|
18
|
Aesthetic Refinements after Radial Free Flap Phalloplasty: Optimizing the Donor Site and the Phallus. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1611. [PMID: 29632786 PMCID: PMC5889466 DOI: 10.1097/gox.0000000000001611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/01/2017] [Indexed: 11/26/2022]
Abstract
Background: Phalloplasty with radial forearm flap is the gold standard for female-to-male sex reassignment surgery. However, it leaves a stigmatizing forearm scar, and as the new phallus is created with the forearm’s skin and fat, it does not look like that of a biological man. The aesthetic appearance of the donor site and the neophallus can be optimized after phalloplasty. In this study, we review refinement techniques (RTs) performed after radial forearm flap phalloplasty. Methods: We present a historical cohort of patients who underwent the following RTs: forearm fat grafting and localized laser in the forearm’s scars, and micropigmentation of the neophallus. Patient’s aesthetic satisfaction was evaluated using the Patient and Observer Scar Assessment Scale for the forearm’s refinements and the Male Genital Self-Image Scale for the neophallus. Results: Between January 2014 and January 2016, 8 patients underwent forearm fat grafting with localized laser, and 7 patients micropigmentation of the neophallus after radial flap phalloplasties. All Patient and Observer Scar Assessment Scale parameters showed a statistically significant reduction between preoperative and postoperative values. Male Genital Self-Image Scale survey showed that all patients felt positively about their genitals after micropigmentation. Patients who underwent refinement procedures were highly satisfied with the aesthetic outcome and felt more confident. They also claim that they would choose to have the refinement procedure done again. Conclusions: The proposed RTs are minimally invasive interventions to complement and enhance female-to-male sex reassignment surgery with very few complications and excellent aesthetic results of both the forearm scars and the constructed phallus.
Collapse
|
19
|
Lee MC, Jang YJ, Yun IS, Lew DH, Lee WJ. Comparative Skin Evaluation After Split-Thickness Skin Grafts Using 2 Different Acellular Dermal Matrices to Cover Composite Forearm Defects. J Hand Surg Am 2017; 42:297.e1-297.e10. [PMID: 28258869 DOI: 10.1016/j.jhsa.2017.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/22/2017] [Accepted: 01/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The combination of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) has been widely adopted to overcome functional and cosmetic limitations of conventional STSG. In this study, we evaluated the efficacy of this combination using 2 types of ADM: cadaveric acellular dermal matrix (CDM) and bovine acellular dermal matrix (BDM). METHODS We recruited 72 patients undergoing autologous STSG to cover radial forearm free flap donor sites. They were included in 1 of 3 therapeutic groups: group 1, STSG using CDM (n = 29); group 2, STSG using BDM (n = 20); and group 3, STSG only (n = 23). Functional skin values for skin elasticity, humidification, transepidermal water loss, and color were determined. Values were compared between graft sites and adjacent normal (control) skin, and between grafted areas of each group. RESULTS All skin defects were successfully reconstructed without graft loss. Groups 1 and 2 demonstrated better elasticity than did group 3, based on the analysis using the ratio of grafted area to control. Grafted areas in all 3 groups exhibited less moisture than did control normal skin. There was less transepidermal water loss in group 1 than in group 3, which implied that CDM application had better barrier capacity against water evaporation. Graft sites of groups 1 and 3 exhibited darker and redder color compared with control areas. CONCLUSIONS Composite forearm defects were successfully restored and exhibited acceptable quality after treatment with an ADM plus STSG. Applying either CDM or BDM under a STSG was a suitable procedure, as verified by objective measurements. Elasticity was well preserved in CDM and BDM groups. However, both ADMs revealed functional impairment of humidification. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Myung Chul Lee
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul, Korea; Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Korea
| | - Yong Jun Jang
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - In Sik Yun
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
20
|
Use of vacuum sealing drainage therapy in the closure of a radial forearm flap donor site defect with a full-thickness skin graft. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
21
|
Ho T, Couch M, Carson K, Schimberg A, Manley K, Byrne PJ. Radial Forearm Free Flap Donor Site Outcomes Comparison by Closure Methods. Otolaryngol Head Neck Surg 2016; 134:309-15. [PMID: 16455382 DOI: 10.1016/j.otohns.2005.09.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE: To compare the functional and aesthetic outcomes of radial forearm free flap (RFFF) donor sites reconstructed with full-thickness skin graft (FTSG), split thickness skin graft (STSG) alone, and STSG overlying an acellular dermal matrix (AlloDerm). STUDY DESIGN AND SETTING: A cross-sectional cohort study at a tertiary care hospital. RESULTS: Twenty-five head and neck cancer patients who underwent reconstruction with RFFF completed the evaluations (STSG = 10, FTSG = 8, STSG with AlloDerm = 7). Subjective evaluations of postoperative function by questionnaires showed no significant differences among the 3 groups ( P = 0.93). In blinded evaluations by surgeons, the STSG group obtained the highest aesthetic outcome score (3.39 of 5.0), followed by FTSG (2.89) and STSG with AlloDerm (2.80). However, the difference was not statistically significant ( P = 0.32). Objective measurements of postoperative function by certified occupational therapists were comparable among the 3 groups with the exception of a mildly decreased range of wrist flexion ( P = 0.036) and ulnar deviation ( P = 0.016) in the FTSG group. CONCLUSIONS: The 3 methods of reconstruction have comparable postoperative functional and aesthetic outcomes. SIGNIFICANCE: Each of the 3 methods of reconstruction has low morbidity and satisfactory aesthetic and functional outcomes. EBM rating: B-2b
Collapse
Affiliation(s)
- Tang Ho
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | |
Collapse
|
22
|
Riecke B, Kohlmeier C, Assaf AT, Wikner J, Drabik A, Catalá-Lehnen P, Heiland M, Rendenbach C. Prospective biomechanical evaluation of donor site morbidity after radial forearm free flap. Br J Oral Maxillofac Surg 2016; 54:181-6. [DOI: 10.1016/j.bjoms.2015.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
|
23
|
Moreno-Sánchez M, González-García R, Ruiz-Laza L, Manzano Solo de Zaldívar D, Moreno-García C, Monje F. Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft. J Oral Maxillofac Surg 2016; 74:204-11. [DOI: 10.1016/j.joms.2015.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
|
24
|
Riecke B, Kohlmeier C, Kreiker H, Suling A, Assaf AT, Wikner J, Hanken H, Heiland M, Gröbe A, Rendenbach C. Long-term biomechanical analysis of donor site morbidity after radial forearm free flap. J Craniomaxillofac Surg 2015; 43:1776-80. [DOI: 10.1016/j.jcms.2015.07.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 07/31/2015] [Indexed: 11/17/2022] Open
|
25
|
Local full-thickness skin graft of the donor arm—a novel technique for the reduction of donor site morbidity in radial forearm free flap. Int J Oral Maxillofac Surg 2015; 44:937-41. [DOI: 10.1016/j.ijom.2015.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/07/2015] [Accepted: 02/25/2015] [Indexed: 11/23/2022]
|
26
|
Hanna TC, McKenzie WS, Holmes JD. Full-Thickness Skin Graft From the Neck for Coverage of the Radial Forearm Free Flap Donor Site. J Oral Maxillofac Surg 2014; 72:2054-9. [DOI: 10.1016/j.joms.2014.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 11/16/2022]
|
27
|
The incidence and risk factors for lower limb skin graft failure. Dermatol Res Pract 2014; 2014:582080. [PMID: 25132847 PMCID: PMC4123529 DOI: 10.1155/2014/582080] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/01/2014] [Indexed: 12/02/2022] Open
Abstract
Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors.
Collapse
|
28
|
Chung J, Bonaparte JP, Odell M, Corsten M. The effect of topically applied tissue expanders on radial forearm skin pliability: a prospective self-controlled study. J Otolaryngol Head Neck Surg 2014; 43:8. [PMID: 24739510 PMCID: PMC4018659 DOI: 10.1186/1916-0216-43-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. METHODS Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant. RESULTS There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [-0.04, 0.12], p = 0.30). CONCLUSIONS This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.
Collapse
Affiliation(s)
| | | | | | - Martin Corsten
- The Department of Otolaryngology - Head & Neck Surgery, Ottawa Hospital - General Campus S3, 501 Smyth Road, Ottawa, Ontario K1H 8 L, Canada.
| |
Collapse
|
29
|
Orlik JR, Horwich P, Bartlett C, Trites J, Hart R, Taylor SM. Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors. J Otolaryngol Head Neck Surg 2014; 43:1. [PMID: 24418459 PMCID: PMC3895707 DOI: 10.1186/1916-0216-43-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 12/16/2013] [Indexed: 11/22/2022] Open
Abstract
Background To assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre. Methods This study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers. Results Pronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient’s and the observers’ subjective evaluations. Conclusions Donor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.
Collapse
Affiliation(s)
| | | | | | | | | | - S Mark Taylor
- Department of Surgery, Division of Otolaryngology, QEII Health Sciences Centre, Faculty of Medicine, Dalhousie University, Suite 3044 - Dickson Building, 5820 University Avenue, Halifax B3H 1 V7 NS, Canada.
| |
Collapse
|
30
|
Bonaparte JP, Corsten MJ, Odell M, Gupta M, Allen M, Tse D. Management of the radial forearm free flap donor site using a topically applied tissue expansion device. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:28-34. [DOI: 10.1016/j.oooo.2013.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/27/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
|
31
|
Faisal M, Rana M, Shaheen A, Warraich R, Kokemueller H, Eckardt AM, Gellrich NC, Rana M. Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap--a randomised prospective trial. Orphanet J Rare Dis 2013; 8:56. [PMID: 23915701 PMCID: PMC3717039 DOI: 10.1186/1750-1172-8-56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.METHODS This study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.RESULTS Average increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with 'P' value > 0.05.CONCLUSIONS Based on the results of this study, there was no significant difference in mouth opening after reconstruction with radial forearm free flap compared to nasolabial flap [corrected].
Collapse
|
32
|
Kim S, Chung SW, Cha IH. Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases. J Korean Assoc Oral Maxillofac Surg 2013; 39:21-6. [PMID: 24471013 PMCID: PMC3858158 DOI: 10.5125/jkaoms.2013.39.1.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 12/18/2012] [Accepted: 01/07/2013] [Indexed: 11/29/2022] Open
Abstract
Objectives Full thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery. Materials and Methods In a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records. Results The width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%). Conclusion FTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.
Collapse
Affiliation(s)
- Somi Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seung-Won Chung
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea. ; Department of Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| |
Collapse
|
33
|
Kaltman JM, McClure SA, Lopez EA, Pedroletti F. Closure of the Radial Forearm Free Flap Donor Site Defect With a Full-Thickness Skin Graft From the Inner Arm: A Preferred Technique. J Oral Maxillofac Surg 2012; 70:1459-63. [DOI: 10.1016/j.joms.2011.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
34
|
Bach CA. The scalp or how to reduce the scarring associated with the harvesting of a split-thickness skin graft in head and neck surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:119-21. [DOI: 10.1016/j.anorl.2011.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/20/2011] [Accepted: 08/11/2011] [Indexed: 11/26/2022]
|
35
|
Bonaparte JP, Corsten M, Allen M. Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study. Clin Otolaryngol 2012; 36:345-51. [PMID: 21651729 DOI: 10.1111/j.1749-4486.2011.02354.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study is to test the hypothesis that using a non-invasive and inexpensive pre-operative tissue expansion device (DynaClose) for radial forearm free-flap donor sites will result in a significant reduction in the cost of both in-hospital and out-of-hospital wound care compared with that of unexpanded radial forearm free-flap donor sites. DESIGN A cohort study consisting of patients previously randomised in a randomised controlled trial. An intention to treat design was utilised. SETTING A large tertiary care centre in eastern Ontario, Canada. PATIENTS Thirty-four patients presenting to Otolaryngology Head and Neck clinic were enroled. Of these patients, 29 were previously enroled in a randomised controlled trial, while an additional five patients were enroled and randomised for the purpose of this study. INTERVENTIONS Patients were randomised to either the treatment (pre-operative tissue expansion, DynaClose Expansion System) or control group. MAIN OUTCOME MEASURES Wound care costs (in US dollars) were calculated for all patients for both in-hospital care and for patients requiring home care. Non-parametric data analysis was utilised for statistical assessment. RESULTS There was a 93% reduction in the use of split-thickness skin grafts in the treatment group. There was a significant reduction in total wound care cost for patients in the treatment group versus the control group (P < 0.0001). Patients in the treatment group required a mean (SD) total of $36.00 (23.50) per patient, while the control group required $277.00 (325.00) of wound care. After excluding the cost of home care, the treatment group continued to have a significant reduction in total and in-hospital wound care costs compared with the control group (P < 0.001). CONCLUSIONS Using a simple, inexpensive and non-invasive method of pre-operative tissue expansion results in a significant reduction in the costs of wound care for both in-hospital and out-of-hospital treatment. The DynaClose dynamic skin expansion system results in a cost-effective method to reduce the need of a split-thickness skin graft for coverage of a radial forearm free-flap donor site.
Collapse
Affiliation(s)
- J P Bonaparte
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, Ottawa, ON, Canada
| | | | | |
Collapse
|
36
|
A comparison of full and split thickness skin grafts in radial forearm donor sites. J Hand Microsurg 2011; 3:18-24. [PMID: 22654413 DOI: 10.1007/s12593-011-0036-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/09/2011] [Indexed: 10/18/2022] Open
Abstract
To formally evaluate the functional and aesthetic outcomes between full versus split thickness skin graft coverage of radial forearm free flap donor sites. A retrospective chart review of 47 patients who underwent pedicled or free radial forearm free flap reconstruction from May 1997 to August 2004 was performed. Comparisons were made between patients who had donor site coverage with split thickness skin grafts (STSG) or full thickness skin grafts (FTSG). There was no statistically significant difference between the STSG and FTSG in the number of post-operative dressings, incidence of tendon exposure, time to healing at the skin graft donor site, and time to healing at the skin graft recipient site. The questionnaire data showed there was a trend toward higher scores with the radial forearm scar aesthetics and satisfaction in the FTSG group. Full thickness skin graft coverage of radial forearm free flap donor site is superior to split thickness skin graft coverage in terms of aesthetic outcome, and has no statistically significant difference in terms of tendon exposure, time to healing at the skin graft donor site, time to healing at the skin graft recipient site, or post operative pain.
Collapse
|
37
|
A Donor-site Preference Utility Study for Three Flaps Used in Lower Extremity Microvascular Reconstruction. Ann Plast Surg 2011; 66:59-61. [DOI: 10.1097/sap.0b013e3181d6e2b9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Murray RC, Gordin EA, Saigal K, Leventhal D, Krein H, Heffelfinger RN. Reconstruction of the radial forearm free flap donor site using integra artificial dermis. Microsurgery 2010; 31:104-8. [PMID: 20939003 DOI: 10.1002/micr.20833] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 08/01/2010] [Accepted: 08/09/2010] [Indexed: 11/09/2022]
Abstract
Autologous skin grafting to the donor site in patients who undergo radial forearm free flap reconstruction (RFFF) is associated with cosmetic and functional morbidity. Integra artificial dermis (Integra Lifesciences, Plainsboro, NJ) is a bovine collagen based dermal substitute that can be used as an alternative to primary autologous skin transplantation of the donor site. We describe a staged reconstruction using Integra followed by ultrathin skin grafting that results in highly aesthetic and functional outcomes for these defects. A retrospective review of 29 patients undergoing extirpative head and neck oncologic resection were examined. Integra graft placement was performed at the time of RFFF harvest followed by autologous split thickness skin grafting at 1 to 5 weeks postoperatively. Healing fully occurred within 4-6 weeks with negligible donor site complications, excellent cosmesis, and minimal scar contracture. Composite reconstruction with Integra artificial dermis offers advantages over traditional methods of coverage for select cases of radial forearm free flap donor site closures.
Collapse
Affiliation(s)
- Ryan C Murray
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Avery CME. Review of the radial free flap: is it still evolving, or is it facing extinction? Part one: soft-tissue radial flap. Br J Oral Maxillofac Surg 2009; 48:245-52. [PMID: 19837491 DOI: 10.1016/j.bjoms.2009.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
The versatile fasciocutaneous radial flap is robust and reliable, straightforward to harvest, and often produces a satisfactory reconstruction with relatively little long-term morbidity at the donor site. Many surgeons prefer to use a limited number of trusted flaps, and these qualities will ensure that in the intermediate future most surgical trainees will continue to be shown the fasciocutaneous radial flap as both the basic training flap and the established option for reconstruction. Evidence from observational clinical studies and one randomised clinical trial indicates that there is increasing support for the use of the evolutionary technique of suprafascial dissection to minimise morbidity at the donor site. The suprafascial donor site may be repaired with either a meshed or unmeshed partial-thickness skin graft, or a fenestrated full-thickness skin graft, with good rates of successful healing. The application of a negative pressure dressing to the wound seems to facilitate the healing of all types of skin graft. The subfascial donor site, however, remains more prone to complications. It may be helpful to position the donor site of the flap more proximally, but this has not been proven. These refinements probably produce the best outcomes that can currently be achieved, given the inherent flaws of the radial donor site.
Collapse
Affiliation(s)
- C M E Avery
- University Hospitals of Leicester, Leicester LE1 5WW, UK.
| |
Collapse
|
40
|
González-García R, Ruiz-Laza L, Manzano D, Moreno C, Maestre O, Serrano H, Villanueva L, Monje F. Combined Local Triangular Full-Thickness Skin Graft for the Closure of the Radial Forearm Free Flap Donor Site: A New Technique. J Oral Maxillofac Surg 2009; 67:1562-7. [DOI: 10.1016/j.joms.2009.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 03/08/2009] [Indexed: 11/30/2022]
|
41
|
|
42
|
Gravvanis AI, Tsoutsos DA, Iconomou T, Gremoutis G. The use of integra artificial dermis to minimize donor-site morbidity after suprafascial dissection of the radial forearm flap. Microsurgery 2008; 27:583-7. [PMID: 17868139 DOI: 10.1002/micr.20406] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In an effort to minimize the radial forearm flap donor-site morbidity, the flap was elevated using the suprafascial dissection technique, in six patients with various facial defects. The donor site was covered primarily with Integra artificial skin and secondarily with an ultrathin split-thickness skin graft. The mean time to wound healing of the forearm donor site was 24 days. There were no flap failures, and all flaps healed uneventfully. At the end of the follow-up, all patients showed normal range of motion of the wrist and the fingers, normal power grip, and power pinch. All patients evaluated the esthetic appearance of the forearm donor site as very good. In conclusion, suprafascial dissection of the forearm flap creates a superior graft recipient site, and the use of Integra artificial dermis is a valuable advancement to further minimize the donor-site morbidity, resulting in excellent functional and aesthetic outcomes.
Collapse
Affiliation(s)
- Andreas I Gravvanis
- General State Hospital of Athens G Gennimatas, Department of Plastic Surgery-Microsurgery and Burn Center J Ioannovich, Athens, Greece.
| | | | | | | |
Collapse
|
43
|
Prospective study of the septocutaneous radial free flap and suprafascial donor site. Br J Oral Maxillofac Surg 2007; 45:611-6. [DOI: 10.1016/j.bjoms.2007.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2007] [Indexed: 11/21/2022]
|
44
|
Closure of radial forearm free flap donor site defect with a local meshed full-thickness skin graft: a retrospective study of an original technique. J Craniomaxillofac Surg 2007; 35:369-73. [PMID: 18032057 DOI: 10.1016/j.jcms.2007.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 07/06/2007] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Closure of the radial free flap donor site remains a problem. Donor site morbidity is related to poor skin graft taking, inaesthetic appearance and hand sensory dysfunction. PATIENTS AND METHODS From January 1998 to December 2002, 41 radial free flaps were harvested. The donor site closure technique consisted of a combination of: flexor tendons coverage, purse string and local meshed full-thickness skin graft. RESULTS The mean time of wound healing of the donor site was 4.68 weeks. Four patients (16%) developed a partial necrosis of the skin graft. Nine patients (36%) showed a definitive hypoaesthesia in the dorsal region of the thumb. Neither total necrosis of the skin graft nor exposure of flexor carpi radialis tendon was noted. The average visual analogue scale of the aesthetics was 6 (patients), 4.18 (students) and 7.2 (first author) out of 10. CONCLUSION This technique for closing a small-to-medium sized radial donor site defect is recommended.
Collapse
|
45
|
Kim TB, Moe KS, Eisele DW, Orloff LA, Wang SJ. Full-thickness skin graft from the groin for coverage of the radial forearm free flap donor site. Am J Otolaryngol 2007; 28:325-9. [PMID: 17826534 DOI: 10.1016/j.amjoto.2006.10.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 10/13/2006] [Accepted: 10/16/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to describe the use of a full-thickness skin graft from the groin for coverage of the radial forearm free flap donor site. Our hypothesis is that the use of the full-thickness skin graft decreases morbidity and improves functional and cosmetic outcome at the skin graft donor site while also providing excellent coverage of the forearm donor site. STUDY DESIGN This study used a retrospective chart review design. MATERIALS AND METHODS Patients undergoing radial forearm free flap reconstructions from 1995 to 2005 were included. Forty patients underwent radial forearm free flap reconstruction with closure of the forearm donor site with a full-thickness skin graft harvested from the groin. The inguinal donor site was closed primarily. Medical records including clinic notes, operative reports, and photographs were reviewed. RESULTS There was 1 minor wound dehiscence at the groin site, and there were 5 minor forearm wound dehiscences with 2 cases of tendon exposure; all dehiscences were treated conservatively with local wound care. Both the groin wound and forearm donor sites healed satisfactorily in all cases, with no impairment of function related to the skin graft. All patients expressed satisfaction with the postoperative pain, functional outcome, and cosmetic appearance related to both the skin graft and forearm donor sites. CONCLUSIONS Full-thickness skin graft from the groin for coverage of the radial forearm free flap donor site is an effective, safe alternative to the traditional split thickness skin graft.
Collapse
Affiliation(s)
- Theresa B Kim
- University of California, San Francisco, Department of Otolaryngology--Head and Neck Surgery, San Francisco, California 94121, USA
| | | | | | | | | |
Collapse
|
46
|
Selvaggi G, Monstrey S, Hoebeke P, Ceulemans P, Van Landuyt K, Hamdi M, Cameron B, Blondeel P. Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast Reconstr Surg 2006; 118:1171-1177. [PMID: 17016186 DOI: 10.1097/01.prs.0000221110.43002.a0] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gennaro Selvaggi
- Gent, Belgium From the Departments of Plastic Surgery and Urology, University Hospital
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Zuidam JM, Coert JH, Hofer SOP. Closure of the donor site of the free radial forearm flap: a comparison of full-thickness graft and split-thickness skin graft. Ann Plast Surg 2006; 55:612-6. [PMID: 16327462 DOI: 10.1097/01.sap.0000185656.66239.ad] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Donor-site complications of free radial forearm flaps (FRFF) after closure with a split-thickness skin graft (STSG) have been reported repeatedly. Different types of closure of the donor site have been advocated to reduce donor-site complications. In our practice, a V-Y closure with a local full-thickness skin graft (FTG) is performed generally. PURPOSE A retrospective follow-up study was performed comparing subjective and objective outcomes of FTG versus STSG closure. FRFF donor site closure in 34 head and neck cancer patients (15 STSG, 19 FTG) was studied. RESULTS Both methods of closure showed good function, sensibility, and esthetic outcome. No statistical differences between the 2 methods could be shown. CONCLUSION V-Y local donor site closure is a good technique which prevents an additional donor site scar and discomfort when performing an STSG closure.
Collapse
Affiliation(s)
- J Michiel Zuidam
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre Rotterdam, The Netherlands
| | | | | |
Collapse
|
48
|
Motomura H, Ohba N, Ohashi N, Harada T, Muraoka M, Iguchi H, Kusuki M, Yamane H. Improvement of the radial forearm donor site by compression with hydrocolloid dressing and adhesive sponge. Acta Otolaryngol 2006; 126:204-8. [PMID: 16428201 DOI: 10.1080/00016480500388968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS With our method, general improvement is obtained as compared with traditional split-thickness skin grafting of the radial forearm flap donor site. As our method is simple and easy, the same results can be obtained wherever and by whomever it is performed. OBJECTIVE The radial forearm flap is associated with complications of graft take and a poor aesthetic appearance despite its usefulness in reconstructing the oral cavity and oropharynx. We describe a simple technique for improvement of the radial forearm donor site. PATIENTS AND METHODS We studied 12 patients who underwent reconstruction with radial forearm free flaps following resection of oral or oropharyngeal tumors. We covered the donor site defect using traditional split-thickness skin grafts and performed aftercare with a hydrocolloid dressing and an adhesive sponge to retain moisture and apply compression. After the treatment series, color matching, texture matching, depressive deformity, and hypertrophic scar were evaluated. RESULTS The results of comprehensive evaluation of the two patients with premature discontinuation of compression were good. One patient was assigned only 1 point for hypertrophic scar, and another only 1 point for color match. The evaluation of the other 10 patients was excellent.
Collapse
Affiliation(s)
- Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Avery CME, Iqbal M, Orr R, Hayter JP. Repair of radial free flap donor site by full-thickness skin graft from inner arm. Br J Oral Maxillofac Surg 2005; 43:161-5. [PMID: 15749218 DOI: 10.1016/j.bjoms.2004.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2004] [Indexed: 11/20/2022]
Abstract
Sixty-two consecutive patients had 63 radial free flaps taken and the donor site repaired with either a full-thickness or split-skin graft. A full-thickness graft was harvested from the inner upper arm in 53 patients (85%). The donor site was assessed using a visual analogue scale, tactile sensitivity, and the Vancouver scar assessment score. All donor sites healed without complications except for two minor wound dehiscences. Both patients and surgeons rated the aesthetic outcome as good. The advantages included; single operation site; simple execution; thin hairless graft, good colour match and an inconspicuous scar causing minimal morbidity.
Collapse
Affiliation(s)
- C M E Avery
- Department of Maxillofacial Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
| | | | | | | |
Collapse
|
50
|
Abstract
The soft tissue of dorsum of the foot consists of a thin pliable surface that allows for significant excursion and tendon gliding. Reconstructive options must preserve these important functions and allow for reasonable contour so the patient may wear a shoe postoperatively. Special attention must be given to the mechanism of injury and overlying pathophysiology involved with each wound. Local flaps can provide adequate wound coverage in settings in which the vasculature and subcutaneous structures have been preserved. In wounds in which the regional vascularity is compromised or in which tendon and bone have been lost, a free-tissue transfer can provide for more substantial coverage. The multiple options available with free-tissue transfer allows for the possibility of composite tissue transfer, including vascularized bone or tendon, and the ability to create a sensate flap with excellent contour.
Collapse
Affiliation(s)
- J M Serletti
- Division of Plastic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 661, Rochester, NY 14642, USA
| | | |
Collapse
|