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.

Comparison of the outcomes of split thickness skin graft versus full thickness skin graft for closure of the radial forearm free flap donor site: A systematic review

“…These studies favoring STSG were also considerably smaller sample sizes in comparison with others in this review that found FTSG superior. The only study on its own to show significance was Krane et al (2020), which favored FTSG. There was little mention of final aesthetics regarding the donor site for the STSG or FTSG.…”

Reducing morbidity in radial forearm free flap donor site: a review of closure techniques

“…Functionally, FTSG has had mixed results when compared to STSG. Some authors have found improved range of wrist motion with FTSG, and others have found the opposite effect [8,20]. FTSG does have the advantage of a closed harvest site with less pain as compared to STSG harvest sites.…”

“…RFFF harvest can cause noticeable deficits in hand and arm use including decreased wrist flexion, decreased grip strength, sensory abnormalities, and loss of strength [1][2][3][4][5][6][7]. Additionally, skin graft failure over the donor site can lead to tendon exposure and wound healing delay in anywhere from 5 to 30% of patients [8][9][10]. Aside from being a cosmetic issue, this can lead to decreased hand function due to scarring [9].…”

Radial Forearm Free Flap for Head and Neck Defect Reconstruction: An Up-to-date Review of the Literature

“…The author concluded that contralateral anastomosis is a safe and successful choice in the reconstruction of head and neck defects, particularly with using a radial forearm free flap [1]. Krane et al compared the aesthetic and morbidity results of split-thickness skin grafts and full-thickness skin grafts in the reconstruction of the donor site of the forearm free flap [24]. The author suggested that using full-thickness skin grafts in the reconstruction of the donor site of the forearm free flap would give a better aesthetic outcome without the morbidity of the donor site or wound creation compared to split-thickness skin grafts [24].…”

“…Krane et al compared the aesthetic and morbidity results of split-thickness skin grafts and full-thickness skin grafts in the reconstruction of the donor site of the forearm free flap [24]. The author suggested that using full-thickness skin grafts in the reconstruction of the donor site of the forearm free flap would give a better aesthetic outcome without the morbidity of the donor site or wound creation compared to split-thickness skin grafts [24]. Gur et al compared current free flap options for intraoral lining and tongue reconstruction.…”