Minimizing free flap donor-site morbidity

Abstract

The techniques described in the current review may improve long-term patient outcomes both esthetically and functionally.

Perforator‐based propeller flap for fibula free flap donor site repair: A novel surgical technique

“…Although the OCFFF is the primary flap choice for reconstruction of composite defects of the mandible and maxilla, commonly employed strategies to close the donor site all have significant morbidity and drawbacks. Primary closure provides a sensate, aesthetically appealing closure of the OCFFF donor site; however, primary closure has a high rate of major and minor complications . In a retrospective case series of 53 patients who underwent OCFFF with either primary closure (n = 26) or STSG (n = 27), Shindo et al reported a greater rate of both major (12% vs. 4%) and minor complications (27% vs. 15%) in donor sites that were closed primarily compared to STSG .…”

“…Complications have been reported in donor sites as small as 2.5 cm . Klein et al reported tension‐induced necrosis occurring in two patients with primary closure and now recommend against primary closure of the fibula donor site, regardless of skin paddle size . STSG closure of the fibula donor site is commonly employed but introduces an additional donor site and has a high rate of partial STSG failure and associated morbidities .…”

“…Klein et al reported tension‐induced necrosis occurring in two patients with primary closure and now recommend against primary closure of the fibula donor site, regardless of skin paddle size . STSG closure of the fibula donor site is commonly employed but introduces an additional donor site and has a high rate of partial STSG failure and associated morbidities . Recently, Sharma et al described a series of 10 propeller flaps based off the posterior tibial artery and showed that the propeller flap is both safe and effective, reporting a complication rate of 20% in their original case series and citing clinical judgement and the learning curve of a novel procedure as the reasoning for their comparable complication rate with previously reported techniques …”

“…The osteocutaneous fibula free flap (OCFFF) is the most frequently utilized free flap for the reconstruction of composite defects involving either the mandible or maxilla due to its long pedicle, the ability to support osseointegrated implants, the length of available bone, and the potential for more than one skin paddle . Closure of the fibula skin paddle donor site commonly occurs via primary closure, split‐thickness skin graft (STSG), or skin‐stretching devices .…”

“…Primary closure only is an option for small skin paddles . STSG closure of the fibula donor site introduces an additional donor site, has a high rate of partial STSG failure with subsequent delayed wound healing, and has poor aesthetic outcomes . Novel techniques to improve aesthetic outcomes of the fibula donor site and minimize patient morbidity are thus required.…”