Closure of radial forearm free flap donor site: A comparative study between keystone flap and skin graft

Abstract

Background: The aim was to investigate the feasibility of radial forearm free flap (RFFF) donor site closure by keystone flap (KF) and compare its outcomes to those of skin graft (SG) closure. Methods: One hundred and one patients who underwent RFFF for head and neck reconstruction were included (35 KF closure and 65 SG closure). Duration of wound healing and donor site complications was collected. After a minimal follow-up of 1 year, patients were questioned about functional and esthetic impairment. Results: Coverage of donor site by KF was successful in all cases. The duration of wound healing was longer after SG than after KF (32 days vs 18 days, P < .001). Healing complications, esthetic and functional results were not statistically different. Conclusion: Forearm donor site closure by KF is a feasible alternative to the traditional SG. Its main advantages are the reduced wound healing time and the avoidance of a second donor site. K E Y W O R D S esthetic and functional results, donor site morbidity, keystone flap, radial forearm free flap, skin graft

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

“…17 Of the 20 studies investigating pain at the donor-site, only one study specifically reported neuropathic pain; however, the authors did not elaborate on the difference between neuropathic pain and general pain. 19 Furthermore, the development of true painful neuromas was reported by six studies, which reported a mean incidence of 5.0%. We believe this is an underestimation of the actual incidence of neuroma formation, as all neuromas were subjectively diagnosed by clinical presentation, and none were objectively diagnosed by a Tinel test.…”

“…Furthermore, hyperesthesia and cold intolerance were reported by 16% and 13% of the patients, respectively. Neuropathic pain is clinically characterized by spontaneous pain or evoked types of pain, including hyperesthesia and cold intolerance [17][18][19] . Iatrogenic nerve injury may trigger a consequence of molecular changes in nociceptive neurons that eventually become abnormally sensitive and develop pathological spontaneous activity.…”

“…A study by Pirlich et al compared functional outcomes between donor-site closure with an FTG or direct closure; however, no substantial difference in pain incidences was found between the two techniques. 28 Four studies used flaps for donor-site closure, including an anterolateral thigh flap 29 , an ulnar-based transposition flap 13 , a bilobed flap 30 , and a keystone flap 19 , however no considerable differences compared to skin graft closure were found. The difficulty in distinguishing the origin of donor-site pain between the different nerves or skin grafts emphasizes how little is known regarding this problem so far, and highlights the importance of investigating this in future studies.…”

Radial Flap in Reconstructions of the Hand - Case Series Study

“…The complications of this method are relatively common, and the aesthetic result is sometimes pure. Therefore, a number of alternative methods have been used: full thickness skin graft, local skin flap, tissue expansion, vacuum assisted closure (VAC), cell cultures, synthetic skin substitutes (35)(36)(37)(38)(39)(40)(41)(42)(43)(44). No one of these is ideal and many researches are still focused on the donor site of RFF (32,34).…”

Променевий Клапоть Передпліччя В Реконструктивній Хірургії Голови Та Шиї. Досвід Застосування Та Вибір Венозної Системи Тканинного Клаптя

“…До переваг ПКП слід віднести: легке виділення тканинного клаптя, надійність, постійність ангіоархітектоніки, достатньо довгу судинну «ніжку», тонку і пластичну тканину клаптя, можливість одночасної роботи двох бригад хірургів. Основним недоліком ПКП є естетичні порушення в донорській ділянці [10,11].…”