Suprafascial dissection of the radial forearm flap and donor site morbidity

A cutaneous free radial forearm flap was harvested from 25 patients using a suprafascial dissection technique. The donor site was managed with either a full or split thickness skin graft and a negative pressure wound dressing. The incidence of initial complete graft take was 96% at day 5 and 100% by 1 month. There was 100% early and complete graft take in the full thickness group but one area of partial loss in the split thickness group. This area of graft loss represented less than 0.5% of the total grafted area in this series. The mean time to wound healing was 14 days. There were no cases of tendon exposure or delayed healing. The suprafascial dissection creates a superior graft recipient bed. When combined with the negative pressure wound dressing technique it ensured early and complete graft take.     

Prospective study of the septocutaneous radial free flap and suprafascial donor site

This is a prospective study of 121 consecutive radial septocutaneous flaps harvested by one surgeon. There were 117 successful flaps (97%). The incidence of early return to theatre for potential problems with the flap or the neck wound was 12/121 (10%) and the flap salvage rate was 3/7 (43%). The incidence of three early wound healing complications at the suprafascial donor site were: loss of the skin graft (4%), tendon exposure (3%) and delayed healing (4%). A full-thickness skin graft, usually from the inner upper arm, was used to repair three-quarters of donor site defects. The median time to healing was significantly longer for partial thickness grafts (14 days compared with 10 days, p<0.001). The degree of contraction of the skin graft used to repair the radial defect was significantly less for full thickness than partial thickness grafts (median -21% compared with -33%, p=0.01). There was more relative contraction with larger grafts (p<0.001) and in older patients (p=0.01). The septocutaneous radial flap is reliable. The early morbidity at the suprafascial donor site is relatively low in comparison to that reported at the subfascial donor site.     

Review of the radial free flap: is it still evolving,or is it facing extinction? Part one: soft-tissue radial flap

The versatile fasciocutaneous radial flap is robust and reliable, straightforward to harvest, and often produces a satisfactory reconstruction with relatively little long-term morbidity at the donor site. Many surgeons prefer to use a limited number of trusted flaps, and these qualities will ensure that in the intermediate future most surgical trainees will continue to be shown the fasciocutaneous radial flap as both the basic training flap and the established option for reconstruction. Evidence from observational clinical studies and one randomised clinical trial indicates that there is increasing support for the use of the evolutionary technique of suprafascial dissection to minimise morbidity at the donor site. The suprafascial donor site may be repaired with either a meshed or unmeshed partial-thickness skin graft, or a fenestrated full-thickness skin graft, with good rates of successful healing. The application of a negative pressure dressing to the wound seems to facilitate the healing of all types of skin graft. The subfascial donor site, however, remains more prone to complications. It may be helpful to position the donor site of the flap more proximally, but this has not been proven. These refinements probably produce the best outcomes that can currently be achieved, given the inherent flaws of the radial donor site.     

对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损

目的: 介绍一种对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损的方法。方法: 对25例口腔鳞癌患者行前臂游离皮瓣修复肿瘤切除术后缺损,在制备前臂游离皮瓣的同时,进行供区对偶三角瓣及邻近小面积全厚皮片的设计和制取,原位修复供区缺损。结果: 25例前臂供区缺损均成功采用供区对偶三角瓣联合原位小面积全厚皮片修复。用于关闭前臂供区缺损的邻近全厚皮片均存活,创口愈合良好,无迟发性创面破裂,未发生供区严重并发症。取瓣侧手臂肘腕关节运动正常,掌部血运正常,前臂皮瓣供区缺损修复区域与周围组织皮肤色泽接近,无凹陷畸形,无挛缩畸形。与腹部取皮组相比,前臂邻近皮片修复组在术后肿胀和腕关节运动没有明显差异的情况下,瘢痕感染几率减少,肌腱外露风险降低,大大提高了前臂术区的美观性。结论: 改良供区对偶三角瓣联合邻近全厚皮片修复技术减少了术中和术后恢复时间,避免第三术区的创伤,值得在临床上应用。     

Closure of radial forearm free flap donor site defect with a local meshed full-thickness skin graft: A retrospective study of an original technique

INTRODUCTION: Closure of the radial free flap donor site remains a problem. Donor site morbidity is related to poor skin graft taking, inaesthetic appearance and hand sensory dysfunction. PATIENTS AND METHODS: From January 1998 to December 2002, 41 radial free flaps were harvested. The donor site closure technique consisted of a combination of: flexor tendons coverage, purse string and local meshed full-thickness skin graft. RESULTS: The mean time of wound healing of the donor site was 4.68 weeks. Four patients (16%) developed a partial necrosis of the skin graft. Nine patients (36%) showed a definitive hypoaesthesia in the dorsal region of the thumb. Neither total necrosis of the skin graft nor exposure of flexor carpi radialis tendon was noted. The average visual analogue scale of the aesthetics was 6 (patients), 4.18 (students) and 7.2 (first author) out of 10. CONCLUSION: This technique for closing a small-to-medium sized radial donor site defect is recommended.     

Treatment of skin graft donor sites with a semipermeable polyurethane dressing

The use of a semipermeable dressing for skin graft donor sites has been described. It permits patients with healing donor sites to ambulate, shower, and wear clothing with no pain during the healing phase. Healing is easily monitored, and signs of infection can be detected early and treated promptly, preventing involvement of the full thickness of the wound. Patients can be discharged from the hospital while the donor site is still healing. The dressing can be removed painlessly at home or in the office. The SPD appears superior to any of the more conventional dressings currently in use for treating skin graft donor sites.     

Repair of the radial free flap donor site with full or partial thickness skin grafts. A prospective randomised controlled trial

The radial forearm free flap has become the mainstay in the reconstruction of soft tissue defects following ablative resection in the oral cavity. The method of repair of the associated forearm tissue defect has been the subject of considerable debate. The options range from direct closure, to local soft tissue flaps or skin graft repair. Larger defects usually require a skin graft and we have routinely used partial thickness skin. An audit of our complication rate led to the consideration of whether a full thickness repair would reduce the morbidity. We randomly allocated successive patients to receive full or partial thickness skin graft repair of the radial donor site in a consecutive series of 68 patients over an 18-month period. Sixty-four patients completed the initial assessment period of wound healing. Thirty seven patients completed a questionnaire at one year to subjectively assess the aesthetic appearance of the forearm wound and the skin graft donor site. They were also assessed for pain at both sites. The partial thickness donor site required significantly more re-dressings. There was no significant difference between the two groups in graft take or number of re-dressings at the recipient site. There was no significant difference in patient assessment of aesthetic appearance or pain in either the forearm recipient site or the skin graft donor site. Provided that an adequate graft is taken, full thickness and partial thickness skin grafts have the same short-term and long-term outcomes in the repair of the radial free flap donor site.     

Closure of radial forearm free flap donor site with local full-thickness skin graft.

A triangular shaped full-thickness skin graft harvested adjacent to the donor site of the radial forearm flap, as originally described by Liang et al, has successfully been used in seven consecutive patients for coverage of the donor site of the radial forearm free flap. In all patients this resulted in a robust coverage with no late wound breakdown and an aesthetic appearance far superior to split-thickness skin-graft coverage. We recommend this technique which is feasible in the majority of cases and reduces both donor site and graft site morbidity of the radial forearm flap.     

Clinical experience with the negative pressure wound dressing

Between 1997 and 1999, more than 300 patients have been treated using negative pressure wound dressings. The technique has been used successfully to prepare various acute, chronic or infected wounds to accept a skin graft or flap, and to promote graft take at difficult donor sites. The advantages include rapid healing by secondary intention, reduced time to skin grafting, an increase in the rate of graft take and a reduction in donor site complications. The dressing can be applied quickly and easily and there have been no serious complications.     

前臂桡侧皮瓣与股前外侧皮瓣修复半舌缺损的比较研究

目的：分析比较前臂桡侧皮瓣与股前外侧皮瓣在修复半舌缺损后的舌功能恢复和供受区并发症情况。方法：2008年7月-2012年11月,23例舌癌患者接受肿瘤扩大切除,遗留的半舌缺损,14例采用前臂桡侧皮瓣修复,供区伤口取腹部全厚皮片移植修复;9例采用股前外侧皮瓣修复。术后4~6个月,对每例患者的吞咽功能、语言清晰度和供受区并发症等情况进行随访分析。结果：前臂桡侧皮瓣组和股前外侧皮瓣组患者吞咽功能和语言清晰度均恢复良好,两组之间无显著差异。在受区,前臂桡侧皮瓣组有1例出现全部皮瓣坏死;股前外侧皮瓣组有1例出现小部分皮瓣坏死,1例出现口颈瘘。在供区,前臂桡侧皮瓣组有4例出现移植皮片部分坏死,1例伤口部分裂开,12例出现明显的瘢痕,9例局部麻木,3例手臂功能障碍;股前外侧皮瓣组有1例局部麻木,1例出现明显的瘢痕,均未出现运动功能障碍。前臂桡侧皮瓣组供区并发症明显多于股前外侧皮瓣组。结论：股前外侧皮瓣可获得的血管蒂长、管径大、供区并发症少,是半舌缺损较理想的修复组织瓣。     

Donor site morbidity after microvascular fibula transfer

The free microvascular fibula and soft tissue transfer has become a widely used method to reconstruct the head and neck region. Only few reports focus on the donor site morbidity of purely mandibular reconstructions. On the basis of the hospital charts, a standardized patient interview and a standardized physical examination, the present study evaluates the early and late donor site morbidity in 42 mostly oncologic patients after an average follow-up interval of 34 months. Of these, 16 patients (38.1%) exhibited complicated wound healing that did not correlate with the patient's age, sex, type of transplant, use of a skin graft, result of preoperative angiography, rate of postoperative mobilization or the incidence of late donor site morbidity. At the time of follow-up examination, about one-fourth of the patients reported discomfort, pain or swelling. Objective findings included sensory deficits in 76.3%, motor deficits in 39.5% and reduced strength in 44.7% of the patients. Even though objectively measured morbidity exceeded subjectively perceived morbidity, it can be concluded that there is significant early and late donor site morbidity, which should be considered when opting for a fibula graft. Patients should be informed accordingly.     

A metabolically active dermal replacement (Dermagraft) for vestibuloplasty

This article describes the use of tissue-engineered dermal replacement in the vestibular extension instead of palatal donor tissue or (split-thickness) skin graft. In three patients the living human-derived fibroblast skin substitute (Dermagraft) was implanted on the wound surface after mucogingival junction and supraperiosteal dissection. Following application of Dermagraft, epithelial closure starting from the resection margins of the defect was observed, obviating further surgical treatment. Vestibular depth was increased and no scarring or frena occurred. Tissue-engineered dermal replacement consisting of living human fibroblasts appears to be a useful substitute for autogenous grafts in pre-prosthetic surgery, offering the advantages of unlimited availability, good colour match and no donor site morbidity.     

Comparison between primary closure and skin grafts of the free fibula osteocutaneous flap donor site

Purpose

This study aimed to compare the size of skin paddles, the postoperative course, and donor site complications between primary closure and skin grafts of the free fibula flap donor site.

Methods

Thirty-five consecutive patients were enrolled. Medical records were retrospectively reviewed for risk factors for delayed healing, size of skin paddles, time to resumption of gait with a mobility aid and self-ambulation, early donor site morbidity, and late donor site complaints.

Results

The harvested skin paddles were significantly wider in the skin graft group than in the primary closure group (P?=?0.02), with no difference in length (P?=?0.1). The difference in time to resuming gait with a mobility aid was also significant (P?=?0.01), but not the time to self-ambulation (P?=?0.9). Two early donor site morbidities (5.7 %) and 12 late donor site complaints (34.3 %) were found. No significant difference in the incidence of early donor site morbidity was observed between two groups. Occurrence of late donor site complaints was not affected by any risk factors.

Conclusions

The width of the harvested skin paddle, but not the length, is one of factors involved in donor site closure. Resumption of gait with a mobility aid, but not self-ambulation, may be delayed in skin graft patients.

     

A prospective placebo-controlled double-blind trial of antibiotic prophylaxis in intraoral bone grafting procedures: a pilot study

OBJECTIVE: A pilot study was conducted to assess the efficacy of a single-dose preoperative prophylactic of the penicillin pheneticillin compared with placebo in the antibiotic prophylaxis of surgical wound infections in intra-oral bone grafting procedures. PATIENTS AND METHODS: Twenty patients (age range 20-45 years) underwent an intra-oral buccal onlay graft procedure. After randomization, a placebo or 2 grams of pheneticillin were administered orally one hour before surgery in a double-blind fashion. During three months, the postoperative course was observed according to clinical parameters of infection. Both groups were homogeneous in their composition and established risk factors for surgical wound infection. The frequency of surgical wound infections, as defined by the Centers of Disease control in 1992, were compared and evaluated statistically. RESULTS: Two patients developed a wound infection at the receptor site; two patients developed an infection at both the receptor and donor sites; and one patient developed an infection at the donor site only. All of these patients received a placebo. No infections were seen in the pheneticillin group. There was a statistically significant increased risk of having an infectious complication after an intra-oral bone graft without antibiotic prophylaxis. CONCLUSION: The results of this study support the efficacy of single-dose, preoperative, oral antibiotic administration.     

The perichondrial cutaneous graft and "flip-flop" flap in facial reconstruction: a series of 41 cases

Reconstruction of defects of the nose and eyelids can be challenging. The standard surgical options include full thickness skin grafts and local flaps. Another technique that offers a reliable and dimensionally stable one-stage reconstruction is the perichondrial cutaneous graft. The donor site is closed with the postauricular flip-flop flap. We have used these techniques in a series of 41 consecutive patients. Good or excellent aesthetic reconstructions were obtained in 39 cases, with 3 complications: 1 failed graft, and 2 small postauricular wound dehiscences. The perichondrial cutaneous graft can produce excellent cosmetic results when it is used to reconstruct complex defects of the nose and eyelid. Closure of the donor site in the conchal bowl with the flip-flop flap is a reliable and elegant technique.     

前臂游离全厚皮片修复前臂游离皮瓣供区缺损的临床观察

目的:观察同侧前臂局部全厚皮片修复前臂游离皮瓣切取后供区缺损的临床效果。方法:27例口腔鳞癌患者,所取前臂皮瓣最小为5cm×6cm,最大为6cm×9cm。前臂皮瓣取下后,按设计在前臂近心端切取三角形不含皮下组织的全厚皮片。关闭伤口时,从近心端向远心端进行,一直到术前设计时指定的一点,剩余三角形区域用切取的全厚皮片覆盖。结果:所有患者移植皮片成活良好,并且获得良好的外观。结论:本方法所植皮片的颜色与周围正常皮肤组织接近,不增加创伤,不增加并发症,不影响功能,具有一定的优势。     

Suction blister skin grafting – a modern application

The suction blistering technique produces an ultra-thin skin graft with no morbidity at the donor site. Negative pressure using wall suction in outpatients is used to generate a graft that can be used for reconstruction, and it avoids the need for invasive procedures in patients with coexisting conditions. The harvested tissue has a low metabolic demand and survival is excellent. We used it in a patient when previous reconstructions after excision of skin cancer had failed. Graft survival was more than 95% by surface area and there was no donor site morbidity. We have found it particularly useful for grafting over Integra^® dermal regeneration template (Integra LifeSciences Corporation, NJ, USA) to produce healing at difficult sites. Patients tolerate the procedure well and the donor site heals quickly. It is useful where recipient vascularity is poor or where coexisting conditions prevent complex procedures.     

改良负压封闭引流术在游离皮瓣修复术后供区植皮中的应用

目的:探讨改良负压封闭引流术(vacuum sealing drainage,VSD)在口腔癌患者游离皮瓣修复术后供区植皮中的应用效果.方法:选择50例口腔癌游离皮瓣修复患者,其中30例采用改良VSD法进行供区植皮后处理,20例患者进行常规加压包扎法处理.采用SPSS 22.0软件包对数据进行统计学分析.结果:改良VS...     

Auricular composite graft for skin defect of the philtrum dimple

Our method of performing an auricular composite graft for a skin defect of the philtrum dimple in a patient whose lip is not damaged and has retained its original softness and elasticity is presented. After resecting the lesion, an auricular composite graft is harvested from the conchal region. The size of the graft is almost the same as the size of the resected lesion, although the cartilage is harvested in an elliptical shape, and its size is approximately 60% in area of the overriding skin of the graft. The graft is harvested from the site, which has a similar curvature to the defect. The cartilage is sutured tightly to the graft bed at a minimum of four points with 6-0 absorbable suture. The transversal axis of the harvested cartilage is sutured as vertically as possible so as to fit the direction of the wrinkle line of the upper lip. The skin is sutured to the defect margin using 5-0 nylon suture. The graft donor site is closed primarily. This method has been used for the closure of six comparatively large skin defects after resecting a skin lesion (pigmented nevus in three cases and hypertrophic scar in three cases) in the philtrum dimple in six patients. In all cases, the upper lip was not damaged and retained its original softness and elasticity. The "take" of the graft was complete in all patients, and the donor site healed without any problem. In all cases, postoperative shrinkage of the graft was not significant during the follow-up period, and the graft had a smooth surface. In addition, no patients suffered from a feeling of discomfort in moving the mouth, and an acceptable shape of the philtrum dimple was achieved in all cases. There were no deformational changes in the graft donor site. In conclusion, our method is valid in the patient whose lip is not damaged and has retained its original softness and elasticity and in whom a full-thickness skin graft is selected as the covering method for a skin defect of the philtrum dimple.     

Negative pressure wound dressing of the radial forearm donor site

Donor site complications of the radial forearm are a significant cause of post-operative morbidity. 15 patients had radial forearm free tissue donor sites treated with split skin grafts and a negative pressure dressing. All grafts showed 100% take at 5 days. The advantages of this technique include rapid healing at an unfavourable graft recipient site, increased graft take and decreased donor site complications. This method is ideally suited for the management of large defects. The dressing can be quickly and easily applied and there have been no significant complications.