“Z-Plasty” Modification of Ulnar-Based Fasciocutaneous Flap for Closure of the Radial Forearm Flap Donor Defect

Abstract

The radial forearm flap is a commonly used method of intra-oral reconstruction, but problems with the donor site are not uncommon. In an attempt to avoid complications, Elliot et al described the use of an ulnar-based flap to obtain direct closure. Where it was not possible to close the proximal defect using V-Y closure, the use of a split skin graft was recommended. We describe a modification of their technique that can potentially obviate the need of a split skin graft when proximal closure is not possible.

Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases

“…To do away with the need for an additional donor site for grafting, primary closure may be considered in small radial defects9. In medium-sized radial defects, Ular flap10, Z-plasty11, or modified Z-plasty of combined Ular flap and Z-plasty12 were introduced. Note, however, that local flap requires wide dissection underneath the local flap.…”

The Reverse-flow Radial Forearm Flap for Soft Tissue Reconstruction of the Wrist and Hand

“…The skin grafted donor site usually produces poor aesthetic results. Various authors have suggested ways to minimize this [18,19]. We agree with others [1] that the handling of the donor site should be quite meticulous and possibly its closure should not be delegated to the inexperienced member of the team.…”

Suprafascial Harvest of the Radial Forearm Free Flap Decreases the Risk of Postoperative Tendon Exposure

“…Ulnar based flaps and modifications of the V-Y transposition flap allow closure of the defect with local tissue but may be impossible for large defects, require additional surgical procedures, and have their own potential complications. 4,14,36 In situations where local tissue is not adequate for coverage and skin grafting is necessary, negative pressure dressings have been proposed as an alternative to static pressure dressings to improve skin graft viability. One study showed modest improvement in skin graft viability with the use of negative pressure dressings 27 ; another showed continued high rates of tendon exposure if the negative pressure dressing was used for less than 6 days.…”

“…4 Numerous methods have been described to combat donor site morbidity and specifically tendon exposure with varying degrees of success. 3,4,14-28…”