Pushing the envelope: Single stage primary closure of large flap donor sites with continuous external tissue expansion

Abstract

Primary closure of large flap donor sites is a well-recognized challenge for reconstructive surgeons. At our institution, we have implemented a novel donor site closure strategy that enables single stage primary closure of large fasciocutaneous flaps while minimizing the morbidity, pain, and inconvenience associated with previously established donor site closure techniques. This strategy utilizes a continuous external tissue expansion (CETE) device to offload tension from a taut primary flap closure by generating progressive laxity in the surrounding soft tissues over the course of approximately one week. A retrospective review of fasciocutaneous flap reconstruction cases between October 2017 and July 2021 at a single institution in which donor site closure was performed through high-tension primary closure with CETE tension-offloading. Seventeen patients underwent high-tension primary closure offloaded with continuous external tissue expansion. Average flap width was 9.0 cm (range 7–11 cm). Average duration of the CETE device use was 6 days (range 1–9 days). Primary donor site wound closure was successfully achieved without complication using this strategy in 15 of 17 patients. Continuous external tissue expansion tension-offloading of high-tension flap closures is a practical means for achieving single stage primary closure of large fasciocutaneous donor sites that can be applied across a wide range of flap harvest sites. The modified technique described here represents a simpler and less morbid strategy for large fasciocutaneous flap closures than the currently accepted alternatives. • High-tension wound closure is at risk for dehiscence and/or excessive scarring. • CETE-assisted tension offloading can help achieve single stage primary closure. • CETE generates progressive laxity of the soft tissues surrounding the donor site. • This technique decreases morbidity and avoids the need for reoperation.