The Use of Integra Artificial Dermis to Minimize Donor-Site Morbidity after Suprafascial Dissection of the Radial Forearm Flap

Author(s): Gravvanis A, Tsoutsos D, Iconomou T, Gremoutis G

Source: Microsurgery 27:583–587, 2007.

Summary:

The authors attempted to minimize radial forearm flap donor-site morbidity in six patients by elevating the flap using the suprafascial dissection technique and covering the donor site initially with Integra artificial skin followed by an ultra-thin split-thickness skin graft 14 days later.  The mean time to wound healing of the forearm donor site was 24 days. There were no flap failures, and all flaps healed uneventfully. At the end of the follow-up, all patients showed normal range of motion of the wrist and the fingers, normal power grip, and power pinch. All patients evaluated the esthetic appearance of the forearm donor site as very good. The authors conclude that suprafascial dissection of the forearm flap creates a superior graft recipient site, and the use of Integra artificial dermis is a valuable advancement to further minimize the donor-site morbidity, resulting in excellent functional and aesthetic outcomes.

For decades the radial forearm flap has been a major workhorse for the reconstruction of skin and soft tissue defects. Despite the numerous advantages that include constant anatomy, long vascular pedicle, and thin pliable skin, the flap carries the potential liability of significant donor-site morbidity. Post-operative complications can include hypertrophic scarring, poor skin graft take, and desiccation that may result in tendon loss.  To prevent the donor-site problems of the radial forearm flap, the suprafascial flap elevation technique was reported in 1996.  Additionally, other reports have documented the use of skin substitutes to close the radial forearm flap donor site.

This report utilizes both the suprafascial dissection technique and Integra artificial skin to minimize donor site morbidity with excellent aesthetic results.  The functional outcomes were similarly superior since the fascial layer was maintained thus limiting potential tendon adhesions. The major disadvantage of this technique is the added cost of the skin substitute and requirement for another trip to the operating room two weeks following surgery for split-thickness skin grafting.  Furthermore, the suprafascial dissection technique is more technically challenging for the less experienced surgeon.


 


Radial, Forearm, Flap, Integra, Artificial, Skin, Donor, Morbidity


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