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. 2012 Jun;32(3):158-63.

Radial forearm free flap surgery: a modified skin-closure technique improving donor-site aesthetic appearance

L Giordano  1 , S Bondi, F Ferrario, B Fabiano, M Bussi
Affiliations

Radial forearm free flap surgery: a modified skin-closure technique improving donor-site aesthetic appearance

L Giordano et al. Acta Otorhinolaryngol Ital. 2012 Jun.

Abstract
in English, Italian

Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Nowadays, the technique for harvesting is standardized, while reconstruction of the forearm donor site defect is somewhat controversial. The authors describe a modified closure technique developed to reduce skin tension that provides subsequent improvement of the cosmetic appearance of the forearm donor site. A series of 43 patients undergoing radial forearm free flap (RFFF) reconstruction is presented, carried out by our ENT department between September 2007 and December 2010. The authors used a modification of the standard triangular full-thickness skin graft (FTSG) technique to close the forearm donor site on 23 patients with a new shape similar to a dagger. Using the Stony Brook Evaluation Scale, the authors analyzed the outcomes of 23 cases employing the dagger-shaped FTSG and compared these with a standard (triangular shaped) reconstructive graft used in 20 earlier patients. The new dagger-shaped graft decreases skin tension and reduces the need of multiple slits in the graft with improved aesthetic outcome; it is an effective method for repair of the forearm donor site with low tension and without the need to harvest the skin graft from the thigh. The technique is simple, reliable and requires no more time than a standard procedure.

Il lembo libero di avambraccio è ancora oggi ampiamente utilizzato nella ricostruzione microvascolare di cavo orale, orofaringe ed ipofaringe. La tecnica di prelievo è standardizzata, mentre la ricostruzione del sito donatore è alquanto controversa. L'autore descrive una nuova tecnica di chiusura della cute dell'avambraccio elaborata per ridurre la tensione sui margini dell'innesto. Nel periodo compreso fra settembre 2007 e dicembre 2010, 43 pazienti sono stati sottoposti ad intervento chirurgico di ricostruzione del cavo orale e dell'oroipofaringe con lembo libero rivascolarizzato di avambraccio. Negli ultimi 23 casi trattati la tecnica di chiusura con innesto triangolare V-Y a tutto spessore è stata modificata e sostituita con un nuovo modello di innesto a forma di pugnale. Utilizzando la Stony Brook Scar Evaluation Scale gli esiti cicatriziali della superficie volare dell'avambraccio sono stati analizzati e confrontati ed è emersa una differenza statisticamente significativa a favore del gruppo di pazienti sottoposti a ricostruzione con innesto modificato (p < 0,01). L'innesto a forma di pugnale riduce la tensione lungo la linea di sutura e ciò consente un numero inferiore di incisioni sull'innesto riducendo l'effetto "a maglie"; ne consegue un miglior risultato estetico a distanza. La tecnica è semplice, affidabile e non richiede un allungamento dei tempi chirurgici.

Keywords: Cosmetic appearance; Radial forearm free flap; Reconstructive surgery; Skin graft.

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Figures

Fig. 1.
Fig. 1.
Radial forearm flap (RFFF) with standard full thickness skin graft (FTSG): triangles between RFFF and FTSG are usually sacrificed because the flap is drawn with round edges.
Fig. 2.
Fig. 2.
Full thickness skin graft with the new shape that preserves more skin (dark grey triangles) compared to the standard technique.
Fig. 3.
Fig. 3.
Aesthetic outcome with a standard technique.
Fig. 4.
Fig. 4.
Aesthetic outcome with the dagger-shaped graft.
Fig. 5.
Fig. 5.
(a) Design of the flap with the dagger-shaped FTSG; (b) Preparation of the graft after placement of the first seven stitches; (c) Outcome and comparison with the pre-operative template.
Fig. 5.
Fig. 5.
(a) Design of the flap with the dagger-shaped FTSG; (b) Preparation of the graft after placement of the first seven stitches; (c) Outcome and comparison with the pre-operative template.
Fig. 5.
Fig. 5.
(a) Design of the flap with the dagger-shaped FTSG; (b) Preparation of the graft after placement of the first seven stitches; (c) Outcome and comparison with the pre-operative template.
Fig. 6.
Fig. 6.
Template of the dagger-shaped FTSG.
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References

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