Retrospective comparison of split-thickness skin graft versus local full-thickness skin graft coverage of radial forearm free flap donor site

The radial forearm free flap (RFFF) was first described by Yang et al. (1997) in 1981 and has since become an established, widely used, and versatile method for defect reconstruction in oral and maxillofacial surgery (Benateau et al., 2002). The method is suitable for soft tissue reconstruction intra- and extraoral, with usage in phalloplasty in female-to-male transgender surgery or various other indications in plastic or reconstructive surgery (Watfa et al., 2017; Schloßhauer et al., 2020). The advantages of this graft are reliable vascular anatomy, preservation of a long vascular pedicle with high caliber vessels, low tissue thickness (fasciocutaneous graft), as well as good accessibility and feasibility, which allows harvesting the flap parallel with tumor resection in oral and maxillofacial surgery (Evans et al., 1994; Ho et al., 2006).

While excellent results can be achieved on the recipient side of the flap, a satisfactory outcome of the donor site is of increasing interest (Swanson et al., 1990; De Witt et al., 2007). Wound healing disorders, exposure of tendons, limited sensitivity and mobility of the wrist have been reported (Richardson et al., 1997). In this respect, a crucial factor is the coverage of the donor site. For this purpose, split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), or direct coverage using a local hatchet flap (Lane et al., 2013) have been proposed. In recent years the use of different dermal substitutes has been recommended because of better aesthetic and functional results (Hunger et al., 2021). In the review by Pabst et al. (2018), FTSG revealed slightly better aesthetic and functional outcome compared to coverage with STSG. With the help of a 3-D-scanner Peters et al. (2021) objectively demonstrated a significantly lower surface deviation for FTSG.

However, another donor site is required for skin graft harvest, as STSG are usually taken from the thigh, and FTSG are often taken from the groin resulting in the risk of potential secondary donor site morbidity (Ito et al., 2005; Orlik et al., 2014). In order to forestall this drawback, several alternative approaches have been described. A particularly feasible approach is the coverage with FTSG from a surgical site like the ipsilateral forearm, to avoid secondary donor site morbidity (González-García et al., 2010; Hanna et al., 2014; Moreno-Sánchez et al., 2016; Riecke et al., 2015a,2015b, 2016).

To the authors’ knowledge, previously, there was no comparison of donor site morbidity between STSG- and the given local FTSG-coverage after RFFF harvest. Although the RFFF is widely used, only few studies address donor site morbidity after skin-graft harvest. A consistent evaluation scheme is not yet established for this purpose (Loeffelbein et al., 2012; Pabst et al., 2018).

The study aimed at comparing outcomes between split-thickness skin graft (STSG) and local ipsilateral full-thickness skin graft (FTSG) after radial forearm free flap defect closure with the help of a comprehensive study protocol including subjective and objective evaluation of function, aesthetics, and patients’ satisfaction.

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