Factors associated with skin graft take in fibula and radial forearm free flap donor sites

Hwang, Michelle S.; Britt, Christopher J.; Vila, Peter M.; Dang, Rajan P.; Fleming, Shannon I.; Patel, Archana; Paniello, Randal C.; Rich, Jason T.; Hanasono, Matthew M.; Desai, Shaun C.

doi:10.1016/j.amjoto.2020.102536

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…Specifically, other factors such as the duration of leg immobilization and the timing of ambulation may have affected complication rates, but these were rarely commented on in the included studies. Indeed, a previous study noted that immobilization by cast is significantly associated with decreased skin graft take rate (Hwang et al, 2020). Furthermore, Zimmermann et al (2001) reported the highest rate of skin graft loss (54.6%), which they suspected was due to the ability to walk on the first postoperative day.…”

Section: Discussionmentioning

confidence: 99%

Closure of a free osteofasciocutaneous fibula flap donor site using local skin grafts or flaps: A systematic review and meta‐analysis

2021

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Background In free osteofasciocutaneous fibula flaps, secondary donor sites are avoided using one of three local closure methods: full‐thickness skin grafts (FTSGs), split‐thickness skin grafts (STSGs), or flaps. This systemic review aimed to evaluate the differences in outcomes among the three groups of closure methods used for free fibula flap defects. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, we systematically searched the PubMed and Web of Science medical databases from inception to January 2021 for articles focused on closure of the free fibula flap donor site using the lower leg area—local skin graft or flap—that mentioned the free fibula flap defect size, and/or complications of the donor site. Study characteristics, free fibula flap size, and short‐term complication rates were extracted for analysis. The pooled complication rates and confidence intervals were calculated based on the random‐effects model. Results Eleven studies were included in the qualitative synthesis, and ten studies were included in the quantitative synthesis (meta‐analysis). The FTSG (n = 79, 52.3%) was the most widely used method, while both STSG (n = 36, 23.8%) and flap (n = 36, 23.8%) were the least commonly used methods. The mean free fibula flap length and width were largest for the flap method (11.5 ± 2.5 cm and 6.0 ± 1.8 cm), and all closure methods were used for free fibula flap widths ≥3 cm. Rates of partial and complete necrosis were highest for the FTSG method (20.3%, p = .95, I2 = 0%) and lowest for the flap method (12.7%, p = .95, I2 = 0%). Conclusion This systemic review indicated that any closure method could be adapted for a free fibula flap width ranging from 3 to 9 cm, and the flap method was associated with the lowest rate of short‐term complications.

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Section: Discussionmentioning

confidence: 99%

Closure of a free osteofasciocutaneous fibula flap donor site using local skin grafts or flaps: A systematic review and meta‐analysis

2021

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“…Head and neck reconstruction requires thoughtful consideration from an esthetic and functional standpoint, which results in utilizing the entire reconstructive ladder. It is not uncommon for head and neck oncologic patients to have multiple risk factors for poor wound healing, such as advanced age, peripheral disease, ongoing smoking, or having previously radiated and/or operated vascular tissue in the area requiring reconstruction [1][2][3]. These patients are inherently poor candidates for complex surgical reconstructions, including free tissue transfer.…”

Section: Discussionmentioning

confidence: 99%

“…The resultant defects tend to impact not only patient esthetic concerns but also impair functions of daily living, including breathing, talking, and eating. Specifically, in the area of head and neck oncologic reconstruction, patients are predisposed to poor wound healing secondary to prior radiation therapy, malnutrition, and common co-morbidities such as smoking and alcohol consumption [1][2][3]. The reconstructive algorithm used in head and neck reconstruction continues to follow the traditionally taught reconstructive ladder, with an emphasis on loco-regional flap and free tissue transfer for larger defects.…”

Section: Introductionmentioning

confidence: 99%

Applications of Synthetic Hybrid-Scale Fiber Matrix in Head and Neck Reconstruction: A Case Series

Horwich,

Sivarajah,

Neskey

et al. 2024

Case Rep Oncol

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Introduction: Patients with head and neck cancer often necessitate complex reconstructions, considering both functional and esthetic concerns. Reconstructions are further complicated by previous radiation therapy and patient co-morbidities, which impair wound healing. A recently introduced synthetic hybrid-scale fiber matrix has been shown to provide durable wound coverage and promote tissue healing as an alternative to traditional biologic allogenic and xenogenic skin substitutes. Case Presentation: Thirteen patients were treated at a single academic hospital between December 1, 2021, and May 1, 2023 with the synthetic matrix in head and neck reconstructions. Reconstructions included exposed muscle, scalp wounds, intra-oral defects, and radial forearm free flap donor sites. Wound sizes ranged from 2 × 2 cm to 18 × 10 cm. Serial photographs were taken to evaluate wound healing at 1, 4, 8, 12, and 16 weeks timepoints after application. Outcomes measured at each timepoint included wound size, presence of granulation tissue, and extent of epithelialization. No hematomas or wound complications were encountered. Complete wound healing was noted between 6 and 12 weeks, dependent on wound size. The synthetic matrix significantly promoted wound healing via early granulation tissue formation and epithelialization, or mucosalization, in all head and neck applications. Scar formation and contracture were acceptable in all cases. Conclusion: The use of synthetic hybrid-scale fiber matrix promotes wound healing and avoids patient morbidity associated with traditional allogenic and biogenic treatments, such as split-thickness skin grafts. This synthetic matrix has been demonstrated to be a valuable asset in the head and neck reconstructive armamentarium.

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Factors associated with skin graft take in fibula and radial forearm free flap donor sites

Cited by 2 publications

References 27 publications

Closure of a free osteofasciocutaneous fibula flap donor site using local skin grafts or flaps: A systematic review and meta‐analysis

Closure of a free osteofasciocutaneous fibula flap donor site using local skin grafts or flaps: A systematic review and meta‐analysis

Applications of Synthetic Hybrid-Scale Fiber Matrix in Head and Neck Reconstruction: A Case Series

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