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

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.

Keywords

microvascular reconstruction free flap radial forearm free flap split-thickness skin graft full-thickness skin graft

Get full access to this article

View all access options for this article.

References

Richardson

Fisher

Vaughan

Brown

. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg. 1997;99:109-115.

Timmons

Missotten

Poole

Davies

. Complications of radial forearm flap donor sites. Br J Plast Surg. 1986;39:176-178.

Bardsley

Soutar

Elliot

Batchelor

. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg. 1990;86:287-292.

Swanson

Boyd

Manktelow

. The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients. Plast Reconstr Surg. 1990;85:258-266.

Bootz

Biesinger

. Reduction of complication rate at radial forearm flap donor sites. ORL J Otorhinolaryngol Relat Spec. 1991;53:160-164.

Boorman

Brown

Sykes

. Morbidity in the forearm flap donor arm. Br J Plast Surg. 1987;40:207-212.

Davis

Sieber

Vandevender

. A comparison of full and split thickness skin grafts in radial forearm donor sites. J Hand Microsurg. 2011;3:18-24.

Kim

Moe

Eisele

Orloff

Wang

. Full-thickness skin graft from the groin for coverage of the radial forearm free flap donor site. Am J Otolaryngol. 2007;28:325-329.

Kim

Park

Yang

Myoung

Lee

. Aesthetic closure of the donor site of a radial forearm free flap with two local curved skin grafts. J Plast Surg Hand Surg. 2016;50:184-186.

10.

Riecke

Assaf

Heiland

, et al. 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;44:937-941.

11.

Karimi

Mahy

Reychler

. 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;35:369-373.

12.

Krishnan

Mitchell

. Ipsilateral full-thickness skin grafts to repair the donor site defect of a radial forearm free flap: a reflection on technique. Br J Oral Maxillofac Surg. 2017;55:209-210.

13.

Liang

Swartz

Jones

. Local full-thickness skin-graft coverage for the radial forearm flap donor site. Plast Reconstr Surg. 1994;93:621-625.

14.

van der Lei

Spronk

de Visscher

. Closure of radial forearm free flap donor site with local full-thickness skin graft. Br J Oral Maxillofac Surg. 1999;37:119-122.

15.

Shiba

Iida

Numata

. Ipsilateral full-thickness forearm skin graft for covering the radial forearm flap donor site. Laryngoscope. 2003;113:1043-1046.

16.

Chambers

Harris

Mitchell

Corrigan

. Comparative study of the ipsilateral full thickness forearm skin graft in closure of radial forearm flap donor site defects. J Craniomaxillofac Surg. 1997;25:245-248.

17.

Giordano

Bondi

Ferrario

Fabiano

Bussi

. Radial forearm free flap surgery: a modified skin-closure technique improving donor-site aesthetic appearance. Acta Otorhinolaryngol Ital. 2012;32:158-163.

18.

Zuidam

Coert

Hofer

. Closure of the donor site of the free radial forearm flap: a comparison of full-thickness graft and split-thickness skin graft. Ann Plas Surg. 2005;55:612-616.

19.

Ghanem

Wax

. A novel split-thickness skin graft donor site: the radial skin paddle. Otolaryngol Head Neck Surg. 2009;141:390-394.

20.

Winslow

Hansen

Mackenzie

Cohen

Wax

. Pursestring closure of radial forearm fasciocutaneous donor sites. Laryngoscope. 2000;110:1815-1818.

21.

Sinha

Shih

Chang

Rice

. Use of AlloDerm for coverage of radial forearm free flap donor site. Laryngoscope. 2002;112:230-234.

22.

Wax

Winslow

Andersen

. Use of allogenic dermis for radial forearm free flap donor site coverage. J Otolaryngol. 2002;31(6):341-345.

23.

Wester

Pittman

Lindau

Wax

. AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg. 2014;150:47-52.

24.

Sleeman

Carton

Stassen

. Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall. Br J Oral Maxillofac Surg. 1994;32:54-55.

25.

Gaukroger

Langdon

Whear

Zaki

. Repair of the radial forearm flap donor site with a full-thickness graft. Int J Oral Maxillofac Surg. 1994;23:205-208.

26.

Avery

Iqbal

Orr

Hayter

. Repair of radial free flap donor site by full-thickness skin graft from inner arm. Br J Oral Maxillofac Surg. 2005;43:161-165.

27.

Kaltman

McClure

Lopez

Pedroletti

. 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;70:1459-1463.

28.

Moreno-Sanchez

González-García

Ruiz-Laza

Manzano Solo de Zaldívar

Moreno-García

Monje

. Closure of the radial forearm free flap donor site using the combined local triangular full-thickness skin graft. J Oral Maxillofac Surg. 2016;74:204-211.

29.

González-García

Ruiz-Laza

Manzano

, et al. 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;67:1562-1567.

30.

Sidebottom

Stevens

Moore

, et al. Repair of the radial free flap donor site with full or partial thickness skin grafts: a prospective randomised controlled trial. Int J Oral Maxillofac Surg. 2000;29:194-197.