Radial Forearm Free Flap Donor Research Articles

The reliability of the "Iberic graft" for covering of the radial forearm free flap donor site

The reliability of the "Iberic graft" for covering of the radial forearm free flap donor site

Functional and cosmetic outcome after closure of radial forearm free flap donor defect with porcine collagen membrane.

Disadvantages of the radial forearm free flap (RFFF) are related to the forearm donor site, which requires skin grafting for closure. Due to that matter, an alternative technique using porcine collagen membrane instead of skin grafting was considered and evaluated for its efficacy of donor defect closure. Ten patients requiring reconstruction of oral & maxillofacial defect underwent the single-staged reconstruction with the RFFF. The flap was elevated and the porcine collagen membrane (Rapiderm(®)) was fixed at the donor site with tie-over dressing. After leaving it for at least 2 weeks, it was replaced with an iodine-coated furazine gauze for continuous healing. The patients did not develop any tendon exposure or infection. All forearms healed within 1 month. The mean graft size harvested was 27.75±3.08cm(2). A greater amount of granulation tissue was formed under the dressing gauze which resulted in a less conspicuous donor site. After 6 months the average scar dimension was 9.48±1.07cm. Appearance was excellent with good wrist motility and skin color. The use of the porcine collagen membrane in the donor site of the RFFF is an alternative approach with less morbidity compared to other techniques. Nevertheless, further studies with a larger number of patients are needed to validate the present findings.

Double-layered collagen graft to the radial forearm free flap donor sites without skin graft.

BackgroundRadial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft.MethodsTwenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27–84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated.ResultsAn average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer.ConclusionsDouble-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.

Stabilizing Morbidity and Predicting the Aesthetic Results of Radial Forearm Free Flap Donor Sites.

BackgroundThe radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap.MethodsIn this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance.ResultsOnly one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars.ConclusionsPerforming the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients.

Prospective clinical analysis of functional and cosmetic results after closure of radial forearm free flap donor defect with porcine collagen membrane (Rapiderm®)

Prospective clinical analysis of functional and cosmetic results after closure of radial forearm free flap donor defect with porcine collagen membrane (Rapiderm®)

Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft

Traditional donor-site closure has been associated with serious esthetic and functional morbidity. The purpose of this study was to assess morbidity in esthetics and function and measure the postoperative complications of the radial forearm free flap (RFFF) donor site after using combined local triangular full-thickness skin grafting. This prospective study of patients who underwent reconstruction of head and neck defects using an RFFF was conducted from July 2008 through December 2014. The donor site was repaired with a combined local triangular full-thickness skin graft. Quality of the scar, color match, tendon exposure, presence of necrosis, dehiscence of the suture, and presence of dysesthesia were recorded and analyzed using SPSS 21.0 software. One hundred consecutive patients (71 male and 29 female) underwent RFFF harvesting. RFFF donor-site defects ranged from 15 to 70 cm2; partial skin graft loss occurred in 7% of patients. Five patients (5%) had small dehiscences of the forearm skin graft, and 2 cases (2%) presented tendon exposure. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Esthetic results were considered excellent in 87%, good in 11%, and suboptimal in 2% of the cases. The combined local triangular full-thickness skin graft is a reliable method for closing RFFF donor-site defects because it obviates a second surgical site, it provides excellent color match and pliability, and it can be used for covering large defects of the donor site.

Comparison of radial forearm flap and thoracodorsal artery perforator flap donor site morbidity for reconstruction of oral and oropharyngeal defects in head and neck cancer

IntroductionReconstruction of the oral cavity and oropharynx after tumour resection often involves the use of free flaps, but donor site morbidity must be taken into account. The radial forearm flap, the flap most commonly used in this setting, leaves a readily visible scar on an exposed region of the body. The thoracodorsal artery perforator flap (TDAP), which possesses the same plastic qualities as the radial forearm flap, leaves a scar that is hidden in the axilla. The purpose of this study was to evaluate the cosmetic results of radial forearm and thoracodorsal artery perforator free flap donor sites. Material and methodsThe medical charts of all patients undergoing reconstruction by a radial forearm or thoracodorsal artery perforator free flap between January 2011 and December 2011 were retrospectively reviewed. The Patient and Observer Scar Assessment Scales and the Vancouver Scar Scale were used to evaluate the quality of the scars. ResultsReconstruction was performed by radial forearm flap in 4 cases and TDAP flap in 7 cases. The PSAS score was significantly lower in the TDAP group than in the radial forearm group (P=0.03), and the OSAS score was higher in the radial forearm group (21.5 versus 14). The Vancouver Scar Scale was significantly higher for radial forearm flap scars than for TDAP scars (8 versus 2.7, P=0.005). ConclusionThis is the first study to compare radial forearm and thoracodorsal artery perforator free flap donor site scars. It demonstrates the minimal TDAP donor site morbidity and the high level of patient satisfaction.

Abdominal or forearm V-Y? Comparison of radial forearm free flap donor site following skin graft reconstruction - what do patients think?

Introduction: The radial forearm free flap remains the workhorse flap for oral and oropharyngeal reconstruction and has stood the test of time. Donor site morbidity can be a problem and multiple methods of wound closure have been described. The easiest and most reliable method is skin grafting. Two networks within our training regions use two different full thickness skin graft donor sites to close the free flap donor area. We set out to measure clinicians and patient's view of these methods.

Full-Thickness Skin Graft From the Neck for Coverage of the Radial Forearm Free Flap Donor Site

This study describes the use of a full-thickness skin graft (FTSG) from the neck to cover the radial forearm free flap (RFFF) donor site in patients undergoing neck dissection and microvascular reconstruction for ablative head and neck oncologic surgery. The authors propose that an FTSG from the neck provides sufficient tissue quantity and quality, fewer surgical sites, and decreased surgical time and cost compared with other FTSG harvest sites and split-thickness skin grafts (STSGs). This was a retrospective study of 50 patients from 2007 to 2012 who underwent ablative surgery for oral and head and neck cancer with concomitant cervical lymphadenectomy and RFFF reconstruction with repair of the donor site using an FTSG harvested along the neck dissection incision. Patients who underwent donor site repair using other techniques, such as ulnar transposition flaps, were excluded. Medical records and perioperative photographs were reviewed. Primary closure of the neck without dehiscence was achieved in all cases. There were no recipient site infections. Minor skin graft loss occurred in a minority of patients and was managed with local wound care until healing by secondary intention. No patients required surgical revision of the forearm. An FTSG from the neck provides adequate coverage for most RFFF harvests and offers favorable functional and esthetic outcomes. The primary advantage is avoiding a third surgical site. Complications were comparable to those using FTSGs from other harvest sites. Importantly, cross-contamination from the head and neck with the forearm was shown not to be an issue.

Comparison of Radial Forearm Free‐Flap Donor Site Dressing Modalities with Temporary Forearm Immobilization

Objectives: 1) Compare the success and complication rates of two dressing techniques for radial forearm free-flap donor sites in patients undergoing short term limb immobilization. 2) Recognize the observed benefit of short-term donor limb immobilization in this population. Methods: This was a prospective, randomized, controlled study of patients undergoing radial forearm free flap reconstruction of head and neck oncologic post-ablative defects from 2010 to 2013 at a single tertiary care center. Participants’ donor sites were covered with split-thickness skin grafts and were randomized into two arms: static pressure dressing and negative pressure dressing groups. All participants underwent immobilization of the donor arm using a custom-fit removable volar splint for 30 days. Data were collected at 2 postoperative time points. Results: Fifty-four patients underwent radial forearm and were enrolled in the study. Twenty-seven patients (50%) received negative pressure dressings, and 27 patients (50%) received static pressure dressings. 100% of enrolled patients were immobilized with custom volar splints. Follow-up data were available for 40 (74%) patients at the time of this writing. The overall complication rate was 20% (n = 8). Within the group of patients with medical co-morbidities, 25% (n = 2) demonstrated donor site morbidity. Conclusions: This study reaffirms both techniques as viable methods for covering radial forearm donor sites; however, there are differences between them in cost and convenience for the patient. Additionally, this follow-up study demonstrates that 30-day immobilization may improve donor site outcome regardless of dressing strategy, as evidenced by an overall decrease in donor site morbidity compared to previously published results on non-immobilized patients.

Management of the radial forearm free flap donor site using a topically applied tissue expansion device

The purpose of this study was to prospectively assess clinical outcomes in patients undergoing a new method of donor site management for radial forearm free flaps. 177 patients underwent reconstruction of ablative defects of the head and neck using a radial forearm free-flap. All patients had topical tissue expansion tapes applied to their forearms preoperatively. Closure rates, healing time and complications associated with the technique were assessed. Ninety-five percent of patients had their donor sites closed primarily with a locally harvested full thickness skin graft. Complications related to the tissue expansion device included a loss of device adhesion (19.3%) requiring reapplication and minor pruritic reactions (4.1%). This system of donor site management has resulted in a significant reduction in the requirement of a split thickness skin graft for coverage of the donor site in a radial forearm free flap without any significant economic cost or patient morbidity.

Radial Forearm Free Flap Donor Site Morbidity<subtitle>Ulnar-Based Transposition Flap vs Split-Thickness Skin Graft</subtitle>

To evaluate morbidity associated with the radial forearm free flap donor site and to compare functional and aesthetic outcomes of ulnar-based transposition flap (UBTF) vs split-thickness skin graft (STSG) closure of the donor site. Case-control study. Tertiary care institution. The inclusion criteria were flap size not exceeding 30 cm(2), patient availability for a single follow-up visit, and performance of surgery at least 6 months previously. Forty-four patients were included in the study and were reviewed. Twenty-two patients had UBTF closure, and 22 had STSG closure. Variables analyzed included wrist mobility, Michigan Hand Outcomes Questionnaire scores, pinch and grip strength (using a dynamometer), and hand sensitivity (using monofilament testing over the radial nerve distribution). In analyses of operated arms vs nonoperated arms, variables obtained only for the operated arms included Vancouver Scar Scale scores and visual analog scale scores for Aesthetics and Overall Arm Function. The mean (SD) wrist extension was significantly better in the UBTF group (56.0° [10.4°] for nonoperated arms and 62.0° [9.7°] for operated arms) than in the STSG group (59.0° [7.1°] for nonoperated arms and 58.4° [12.1°] for operated arms) (P = .02). The improvement in wrist range of motion for the UBTF group approached statistical significance (P = .07). All other variables (Michigan Hand Outcomes Questionnaire scores, pinch and grip strength, hand sensitivity, and visual analog scale scores) were significantly better for nonoperated arms vs operated arms, but no significant differences were observed between the UBTF and STSG groups. The radial forearm free flap donor site carries significant morbidity. Donor site UBTF closure was associated with improved wrist extension and represents an alternative method of closure for small donor site defects.

Hinged Forearm Split-Thickness Skin Graft for Radial Artery Fasciocutaneous Flap Donor Site Repair

To present a modified technique in the harvest and application of split-thickness skin graft (STSG) from the primary flap donor site in forearm fasciocutaneous free flaps. A prospective review was performed on 16 consecutive patients who had undergone a radial forearm free flap procedure for reconstruction of head and neck defects with a hinged forearm STSG used to reconstruct the flap donor site defect. Sixteen patients with a mean (SD) defect size of 53.7 (29.9) cm(2) underwent the hinged STSG procedure. A hinged STSG was successfully harvested from all patients without disruption. Graft take was greater than 90% in all patients by postoperative day 7. A secondary skin graft donor site was avoided in all but 2 patients. Good color match of the deepithelialized flap with surrounding oral and pharyngeal mucosa was observed. Visible scarring along the graft hinge margin was absent. No bridging scars resulted from the deepithelialized flaps. The hinged STSG from the forearm is a reliable method of repairing radial forearm free flap donor site defects and offers the advantages of reduced suture line scarring, minimal STSG disruption, low or no secondary donor site morbidity, and good color match at the donor and recipient flap sites.

Closure of the Radial Forearm Free Flap Donor Site Defect With a Full-Thickness Skin Graft From the Inner Arm: A Preferred Technique

Over the past 20 years, microvascular free tissue transfer has become the primary choice for reconstruction of acquired or developmental defects of the head and neck. Multiple free flaps have been described and used for reconstruction of the inherently challenging defects of this region, effectively meeting the demands of reestablishing form and function. The radial forearm free flap is particularly popular because of ease of harvest, versatility, minimal morbidity, and predictable successful outcomes. Although the radial forearm free flap is highly reliable, there remains the problem of closing the distal forearm donor site defect. Primary closure is not feasible in most of these defects because of the paucity of soft tissues in the area, as well as the potential of placing the distal upper extremity in danger of ischemia. 1 Sidebottom A.J. Stevens L. Moore M. et al. Repair of the radial free flap donor site with full- or partial-thickness skin grafts: A prospective randomised controlled trial. Int J Oral Maxillofac Surg. 2000; 29: 194 Abstract Full Text PDF PubMed Google Scholar Although the literature is replete with a variety of techniques for closure of these defects, currently there remains no adopted standard procedure.

The SNaP Wound Care System for Head and Neck Wound Closure

Objective: Vacuum-assisted closure of head and neck wounds has been previously described. Negative pressure wound therapy, although efficacious, has practical limitations in the outpatient setting. The purpose of this study is to describe a novel method of treating complex head and neck wounds using an ultraportable mechanical vacuum wound care system. Method: A cohort study at 2 tertiary care centers. All head and neck patients with complex, low to moderately exudative wounds were treated by the senior author using the SNaP Wound Care System. Patient comorbidities, wound etiology, site, length of treatment, outcomes, and ancillary procedures were recorded. Results: A variety of wounds was treated with this system and included mucocutaneous fistulas, a tracheocutaneous fistula, soft tissue defects of the head and neck, and tendon exposure of a radial forearm free flap donor site. Outpatient SNaP therapy was utilized in five patients with 6 small- to medium-sized wounds. This system was successful in obtaining wound closure in all patients. These patients were able to complete routine activities of daily living, participate in public social settings, and tolerate therapy without adverse events. One patient required an adjunctive procedure of split thickness skin grafting. Conclusion: This study demonstrates a novel use of the first FDA-approved ultraportable, mechanical negative pressure device in the treatment of several complex head and neck wounds. The device has utility in the outpatient setting for adjunctive closure of wounds with minimal disturbance to patients’ activities of daily living and lifestyle.

Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study1

The objective of this study is to test the hypothesis that using a non-invasive and inexpensive pre-operative tissue expansion device (DynaClose) for radial forearm free-flap donor sites will result in a significant reduction in the cost of both in-hospital and out-of-hospital wound care compared with that of unexpanded radial forearm free-flap donor sites. A cohort study consisting of patients previously randomised in a randomised controlled trial. An intention to treat design was utilised. A large tertiary care centre in eastern Ontario, Canada. Thirty-four patients presenting to Otolaryngology Head and Neck clinic were enroled. Of these patients, 29 were previously enroled in a randomised controlled trial, while an additional five patients were enroled and randomised for the purpose of this study. Patients were randomised to either the treatment (pre-operative tissue expansion, DynaClose Expansion System) or control group. Wound care costs (in US dollars) were calculated for all patients for both in-hospital care and for patients requiring home care. Non-parametric data analysis was utilised for statistical assessment. There was a 93% reduction in the use of split-thickness skin grafts in the treatment group. There was a significant reduction in total wound care cost for patients in the treatment group versus the control group (P < 0.0001). Patients in the treatment group required a mean (SD) total of $36.00 (23.50) per patient, while the control group required $277.00 (325.00) of wound care. After excluding the cost of home care, the treatment group continued to have a significant reduction in total and in-hospital wound care costs compared with the control group (P < 0.001). Using a simple, inexpensive and non-invasive method of pre-operative tissue expansion results in a significant reduction in the costs of wound care for both in-hospital and out-of-hospital treatment. The DynaClose dynamic skin expansion system results in a cost-effective method to reduce the need of a split-thickness skin graft for coverage of a radial forearm free-flap donor site.

Reconstruction of the radial forearm free flap donor site using integra artificial dermis

Autologous skin grafting to the donor site in patients who undergo radial forearm free flap reconstruction (RFFF) is associated with cosmetic and functional morbidity. Integra artificial dermis (Integra Lifesciences, Plainsboro, NJ) is a bovine collagen based dermal substitute that can be used as an alternative to primary autologous skin transplantation of the donor site. We describe a staged reconstruction using Integra followed by ultrathin skin grafting that results in highly aesthetic and functional outcomes for these defects. A retrospective review of 29 patients undergoing extirpative head and neck oncologic resection were examined. Integra graft placement was performed at the time of RFFF harvest followed by autologous split thickness skin grafting at 1 to 5 weeks postoperatively. Healing fully occurred within 4-6 weeks with negligible donor site complications, excellent cosmesis, and minimal scar contracture. Composite reconstruction with Integra artificial dermis offers advantages over traditional methods of coverage for select cases of radial forearm free flap donor site closures.

Tissue Expansion of Radial Forearm Free Flap Donor Sites

Tissue Expansion of Radial Forearm Free Flap Donor Sites

Combined Local Triangular Full-Thickness Skin Graft for the Closure of the Radial Forearm Free Flap Donor Site: A New Technique

Combined Local Triangular Full-Thickness Skin Graft for the Closure of the Radial Forearm Free Flap Donor Site: A New Technique

A randomized, prospective, controlled study of forearm donor site healing when using a vacuum dressing

Objective 1) Compare skin graft healing of the radial forearm free flap (RFFF) donor site when using a negative pressure dressing (NPD) versus a static pressure dressing (SPD). 2) Examine the association of graft size and medical comorbidities with healing of RFFF donor site. Study Design Randomized, controlled trial. Setting Tertiary care hospital. Subjects and Methods After the study was approved, consenting adults undergoing RFFF for head and neck reconstructions were randomized into two arms: SPD and NPD groups. Fifty-four patients were enrolled from March 2007 to August 2009. Pre- and postoperative data were collected, including medical comorbidities, graft size, and area of graft failure/tendon exposure. Data were collected at two postoperative time points. Results The overall wound complication rate was 38 percent (19/50). Wound complications at the first postoperative visit (44.4% [12/27] SPD and 30.4% [7/23] NPD) were not significantly different between groups ( P = 0.816). Similarly, wound complications at the second visit (68.8% [11/16] SPD and 80% [12/15] NPD) were not significantly different ( P = 0.55). Percentage of area of graft failure between the groups also showed no difference (4.5% SPD vs 7.2% NPD, P = 0.361). The association of graft size with wound complications was analyzed by dividing the data set into three groups (<50 cm 2, 51-100 cm 2, and >100 cm 2). This difference was not found to be significant ( P = 0.428). Finally, when evaluating comorbidities, 50 percent (8/16) of subjects with comorbidities experienced complications compared with 32.4 percent (11/34) without comorbidities, also not reaching significance ( P = 0.203). Conclusions Although an attractive option for wound care, the NPD does not appear to offer a significant improvement over an SPD in healing of the RFFF donor site.