Use of Skin Grafts in Free Flap Reconstruction

Abstract

Free flap reconstruction often results in a composite defect at the donor site. Many of these defects can be closed primarily (scapular free flaps, rectus abdominis free flap, and antero‐ lateral thigh free flaps). However, some donor sites, such as fibular free flaps and radial forearm free flap, are particularly difficult to close primarily and require the use of skin grafts for coverage of the underlying muscle and tendon. There are several options available for obtaining material to cover the donor site defect. 1. Split thickness skin grafts harvested from a different anatomical site than free flap do‐ nor site 2. Split thickness skin graft harvested from the free flap donor site 3. Full thickness skin grafts harvested from a site adjacent to free flap donor site Coverage with a skin graft compared to primary closure has not been shown to have in‐ creased complication rates [1] and decreases wound tension leading to less wound contrac‐ ture, or worst yet, compartment syndrome [2]. We will discuss the different options for closure of free flap donor sites with skin grafts and the techniques to employ these options in the clinical practice.