Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy

Abstract

Background Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD. Methods Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications. Results Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively ( P = 0.016). Flexion at seven days was improved in NPD group ( P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation. Conclusions In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.

Negative‐pressure wound therapy for donor‐site closure in radial forearm free flap: A systematic review and meta‐analysis

“…Five studies reported skin graft complications, and no significant difference in these complications was identified in all studies 28‐31 . Chio et al reported 7 (30.4%) and 12 (44.4%) cases of skin graft complications at 2 weeks after surgery in the NPWT and control groups, respectively 29 .…”

Postoperative management of lower limb split-thickness skin grafts in Australia

“…36 A similar result is seen with the donor area for a free fibula flap, with two studies showing no significant difference in graft take. 25,28 Bach 28 and Clark 36 did, however, find a significantly shorter healing time in the NPWT group-67 days compared with 163 in the bolster dressing group (p<0.02). Kim used a one-stage Alloderm and SSG procedure comparing NPWT with standard dressings and achieved significantly better results.…”

“…33 The free radial forearm donor site has been studied by multiple groups (Table 2). [34][35][36][37][38] The majority of these studies do not show a significant improvement in graft take, though other advantages have been reported including improved early function. 36 A similar result is seen with the donor area for a free fibula flap, with two studies showing no significant difference in graft take.…”

“…[34][35][36][37][38] The majority of these studies do not show a significant improvement in graft take, though other advantages have been reported including improved early function. 36 A similar result is seen with the donor area for a free fibula flap, with two studies showing no significant difference in graft take. 25,28 Bach 28 and Clark 36 did, however, find a significantly shorter healing time in the NPWT group-67 days compared with 163 in the bolster dressing group (p<0.02).…”

Short- and long-term efficacy of negative-pressure wound therapy in split-thickness skin grafts: a retrospective study

“…Regardless, a randomized controlled trial showed that NPWT significantly improved the appearance of split-thickness skin grafts (STSGs) two weeks after surgery compared with standard packaged dressings (13), and another randomized controlled trial found that NPWT improved the scar color of STSGs (14). In contrast, the results of other randomized controlled trials have indicated that NPWT did not improve the quality or esthetic appearance of scars in STSGs compared with traditional dressings (15).…”