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Acellular Dermal Matrix in the Reconstruction of Radial Forearm Flap Donor Site Wounds - A Prospective Study
Naveen K. Ahuja, MD, Ramazi O. Datiashvili, MD, PhD.
UMDNJ-NJMS, Newark, NJ, USA.
The radial forearm free flap (RFFF) is a versatile free flap that is extensively utilized in head and neck reconstruction as well as for numerous other reconstructive needs. Reconstruction of the donor site is often regarded as an afterthought as most often a simple split thickness skin graft is employed for coverage. The RFFF donor site wound is, however, a complex wound with multiple tissue types present in the wound bed. Graft failure over exposed tendon and subsequent need for tendon excision and additional skin grafting is not uncommon.
Ten consecutive patients undergoing RFFF reconstruction of a head and neck defect at our institution prospectively had their RFFF donor site treated with monolayer Integra wound matrix covered by a split thickness skin autograft. The clinical outcomes were determined by initial graft take, wound appearance at first follow up visit, and whether additional operations were needed to address the donor site. As a control group, the charts of the ten consecutive RFFF patients immediately preceding utilization of Integra were reviewed.
The two groups did not differ significantly with respect to demographics, wound size, or number of exposed structures. Of the Integra wound matrix group, all skin grafts were found to be greater than 95% take, without evidence of exposed tendon in any patients. One patient required re-operation and skin grafting for his donor site, though he had questionable care of his donor site at an extended care facility and did not require tendon excision. Of the control group, four patients required tendon debridement or excision and an additional split skin autograft. Also time to healing was significantly less in the Integra group.
Integra wound matrix decreases the need for additional surgical interventions to address RFFF donor sites and the need for tendon excision while still allowing closure of the donor site in a single stage.
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