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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentations 3 - Facial Plastic and Reconstructive Surgery

Timing of Split Thickness Skin Grafting for Radial Forearm Free Flaps on Donor Site Morbidity

Tuesday, October 1, 2024
11:12 AM – 11:18 AM EDT
Location: MBCC, 222
Disclosure(s):
Angela E. Alnemri, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Annie E. Moroco, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Neha Garg, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matt Davis, BArch:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Arielle G. Thal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Howard D. Krein, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan N. Heffelfinger, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The radial forearm free flap (RFFF) is a versatile and frequently used free flap in the reconstruction of head and neck defects. There is little consensus on the optimal technique for reconstructing RFFF donor site defects. Our group previously reported early results using staged reconstruction with initial placement of Integra, a dermal regeneration matrix, followed by a split thickness skin graft (STSG) resulting in excellent aesthetic and functional outcomes. Here we provide our 12-year experience using staged STSG compared to primary STSG for the reconstruction of RFFF donor site defects.

Methods: Patients undergoing RFFF reconstruction of head and neck defects at a single institution between May 2012 and April 2023 were retrospectively reviewed. Primary versus staged STSG placement was compared in terms of donor site morbidity: hematoma/seroma, infection, skin graft breakdown, tendon exposure, hyperpigmentation, hypertrophic scarring, thenar paresthesia, extremity weakness, and excessive scar contracture.

Results: A total of 179 patients were included: 46 (25.7%) primary STSG and 133 (73.3%) staged STSG. Mean time to STSG in the staged group was 28.4 (±10.2) days. Following primary STSG, 34 (73.9%) patients had a vacuum-assisted closure (VAC) and 12 (26.1%) had an iodine-coated petroleum gauze bolster placed. In the staged STSG group, all patients had a VAC after Integra placement. After the second stage, 30 (22.6%) patients had a VAC, and 103 (77.4%) patients had a bolster placed. Compared to the staged group, the primary group had a significantly higher rate of skin graft breakdown (21.7% vs 6%; p = 0.008) and tendon exposure (19.6% vs 3.8%; p = 0.002). In the staged group, bolster placement was associated with a lower rate of skin graft breakdown compared to VAC (2.9% vs 16.7%; p = 0.015). No other significant differences were observed between the two groups.

Conclusions: When reconstructing donor site defects following RFFFs, staged reconstruction with initial placement of Integra followed by STSG and bolster placement may result in lower rates of skin graft breakdown and tendon exposure.

    Presenting Author(s)

  • Angela E. Alnemri, MD

    Resident Physician
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Annie E. Moroco, MD

    Resident Physician
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Neha Garg, BA

    Medical Student
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • KB

    Kelly M. Bridgham, MD

    Resident Physician
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

    Disclosure information not submitted.

  • Matt Davis, BArch

    Medical Student
    Sidney Kimmel Medical College, Thomas Jefferson University
    West Chester, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • AM

    Adam McCann, MD

    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital, United States

    Disclosure information not submitted.

  • AT

    Arielle G. Thal, MD

    Assistant Professor
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Howard D. Krein, MD, PhD

    Professor
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Ryan N. Heffelfinger, MD

    Professor, Department of OTO-HNS
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.