Long-term follow-up of donor site morbidity after defect coverage with Integra following radial forearm flap elevation

Abstract

BackgroundThe radial forearm flap (RFF) is known for its excellent and reliable results regarding defect coverage though donor site morbidity represents a persisting problem. Integra is widely used in reconstructive surgery. This study aims to assess long-term outcomes regarding functionality and cosmesis after donor site coverage with respect to esthetic appearance, scar quality, and wrist function as well as ability to work after donor site coverage with Integra and split-thickness skin.MethodsThe prospective follow-up exam, after a mean time of 23.8 months, enrolled 13 patients. Identification of patients’ comorbidities and evaluation of the subjective esthetic outcome, sensibility, cold intolerance, and scar instability was assessed by a questionnaire. In clinics, designed Pinch test assessed scar tissue mobility over the flexor tendons. The Vancouver Scar Scale (VSS) was calculated; wrist function and grip strength were determined.ResultsThe satisfaction score for the esthetic appearance of the donor site was in average 3.42 ± 0.44. Two patients experienced an unstable scar and cold intolerance. The VSS resulted in a value of 4.2 representing a good result. The pinch test revealed an average scar mobility of 8 mm without any tendon adhesions. Active range of motion of the wrist was equal to the non-operated site as was grip strength. The pinch test showed a significant negative correlation with the VSS making it a reliable tool to measure scar quality.ConclusionLong-term results show an esthetic and functional successful defect coverage of the RFF donor site by the use of Integra and split-thickness skin.Level of Evidence: Level IV, therapeutic study.

Use of amniotic membrane for radial forearm free flap donor site coverage: clinical, functional and cosmetic outcomes

“…The secondary outcome measures at the 12-month followup included assessments of the subjective patient-related and the objective clinician-based aesthetic and functional outcome parameters. The objective clinician-based outcome measures included evaluation of the aesthetic outcome using the Vancouver scar scale (VSS), assessment of hand/wrist sensibility and functionality as well as determination of the grip [35,36]. The subjective patient-based outcomes evaluated the subjective aesthetic and functional outcome using appropriate questionnaires.…”

“…(1) For the clinician-based aesthetic evaluations, scar scale quality was determined using the modified Vancouver scar scale (VSS). This version of the modified VSS assesses the four different subgroups of pigmentation, vascularity, pliability, and height as described in previous studies [35,36]. All scars were photographically documented, and the VSS rating of the defect area was provided by 2 independent, blinded assessors (H.S.…”

Phalloplasty in Female-to-Male Transsexuals by Gottlieb and Levine's Free Radial Forearm Flap Technique—A Long-Term Single-Center Experience Over More than Two Decades

“…12 However, the donor site on the forearm may be a stigma in daily life. 4,[9][10][11][12][13]16 Other disadvantages consist of limited functional efficacy of the phalloplasty before implantation of an erectile device and the relatively high rate of urologic complications and delayed wound healing. 1,3,[5][6][7][8] According to Van Caenegem et al and others, female-tomale transsexuals "consider the radial forearm flap as worthwhile for phalloplasty," despite the donor-site morbidity.…”

“…10 According to Ito et al, the appearance of the grafted and exposed forearm bothers the patient the most. 13,16 Selvaggi et al describe a good overall acceptance of the donor site after long-term follow-up. 4,5 ►Fig.…”

“…The main disadvantages of the radial forearm penoid consist in a relatively high rate of urologic complications such as fistulas and strictures of the urethra, as well as in disfiguring donor-site morbidity on the forearm. 1,4,5,[8][9][10]13 Pedicled flaps are mainly used as a "salvage procedure" under difficult anatomic conditions or in multimorbid patients. 1,2 The goal of this study was to evaluate the postoperative outcome focusing on major and minor complications by adopting the technique of Gottlieb and Levine, 15 since less representative data are available in the current literature.…”