AlloDerm with Split-Thickness Skin Graft for Coverage of the Forearm Free Flap Donor Site

被引:30
作者
Wester, Jacob L. [1 ]
Pittman, Amy L. [2 ]
Lindau, Robert H. [3 ]
Wax, Mark K. [2 ]
机构
[1] Univ Calif Los Angeles, Dept Head & Neck Surg, Los Angeles, CA USA
[2] Oregon Hlth & Sci Univ, Dept Otolaryngol Head & Neck Surg, Portland, OR 97239 USA
[3] Univ Nebraska Med Ctr, Dept Otolaryngol Head & Neck Surg, Omaha, NE USA
关键词
free flap; microvascular; radial forearm; head and neck; AlloDerm; donor site; RECONSTRUCTION; OUTCOMES; CLOSURE; DERMIS;
D O I
10.1177/0194599813513713
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Objective Major causes of donor site morbidity after free flap harvest are lack of split-thickness skin graft (STSG) take and tendon exposure. Long-term cosmesis remains poor. AlloDerm has shown cosmetically better donor site healing, albeit prolonged healing. We sought to evaluate the use of STSG with AlloDerm compared with STSG alone. Study Design Case series with chart review. Setting Academic tertiary care medical center. Methods and Subjects Institutional review board-approved study. Microvascular database queried from 2002 to 2012. Subjects with forearm free flaps and either AlloDerm + STSG or STSG alone for donor site reconstruction were included. Morbidity outcomes were compared. Results Eighty patients (50 male, 30 female) received AlloDerm + STSG at the donor site. Major and minor donor site complications were 15.0% and 18.8% in the AlloDerm + STSG group compared with 10.2% and 16.9% in the STSG-only group (P = .30 and P = .72), respectively. Complete STSG loss (5.0% vs 3.0%, P = .48), tendon exposure (5.0% vs 5.4%, P = 1.0), functional impairment (2.5% vs 1.8%, P = .66), infection (8.8% vs 9.6%, P = 1.0), hematoma/seroma (5.0% vs 3.6%, P = .73), and paresthesia (1.3% vs 3.6%, P = .43) were not significant. No patients required a second STSG after loss in the AlloDerm + STSG group compared with 60% (P = .17). Cosmetic results were superior in the AlloDerm + STSG group as rated by the surgeon (3.5 vs 2.6, P = .03) and patients (3.7 vs 2.9, P = .05) on a scale of 1 to 5. Conclusion Our results suggest that the use of AlloDerm with STSG can provide thicker coverage of the forearm defect, with minimal donor site morbidity and superior cosmetic results compared with STSG alone.
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页码:47 / 52
页数:6
相关论文
共 12 条
[1]   Donor site morbidity of the fasciocutaneous radial forearm flap: what does the patient really bother? [J].
de Witt, Christien A. ;
de Bree, Remco ;
Verdonck-de Leeuw, Irma M. ;
Quak, Jasper J. ;
Leemans, C. Rene .
EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, 2007, 264 (08) :929-934
[2]   Free Flap Reconstruction of Lateral Mandibular Defects: Indications and Outcomes [J].
Dean, Nichole R. ;
Wax, Mark K. ;
Virgin, Frank W. ;
Magnuson, J. Scott ;
Carroll, William R. ;
Rosenthal, Eben L. .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2012, 146 (04) :547-552
[3]   A novel split-thickness skin graft donor site: The radial skin paddle [J].
Ghanem, Tamer A. ;
Wax, Mark K. .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2009, 141 (03) :390-394
[4]   Radial forearm free flap donor site outcomes comparison by closure methods [J].
Ho, T ;
Couch, M ;
Carson, K ;
Schimberg, A ;
Manley, K ;
Byrne, PJ .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2006, 134 (02) :309-315
[5]   Evaluation of the donor site in patients who underwent reconstruction with a free radial forearm flap [J].
Ito, O ;
Igawa, HH ;
Suzuki, S ;
Muneuchi, G ;
Kawazoe, T ;
Saso, Y ;
Onodera, M ;
Park, S ;
Hata, Y .
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, 2005, 21 (02) :113-117
[6]   Use of the artificial dermis for free radial forearm flap donor site [J].
Lee, JW ;
Jang, YC ;
Oh, SJ .
ANNALS OF PLASTIC SURGERY, 2005, 55 (05) :500-502
[7]  
Loeffelbein Denys J, 2012, Eplasty, V12, pe9
[8]   Acellular dermal composite allografts for reconstruction of the radial forearm donor site [J].
Rowe, Norman M. ;
Morris, Luc ;
Delacure, Mark D. .
ANNALS OF PLASTIC SURGERY, 2006, 57 (03) :305-311
[9]   Use of AlloDerm for coverage of radial forearm free flap donor site [J].
Sinha, UK ;
Shih, C ;
Chang, K ;
Rice, DH .
LARYNGOSCOPE, 2002, 112 (02) :230-234
[10]   Use of allogenic dermis for radial forearm free flap donor site coverage [J].
Wax, MK ;
Winslow, CP ;
Andersen, PE .
JOURNAL OF OTOLARYNGOLOGY, 2002, 31 (06) :341-345