Complications and Morbidity of the Donor and Recipient Sites in 123 Lateral Arm Flaps

The lateral arm flap is a reliable and versatile free tissue transfer. However, the donor and recipient sites may produce an assortment of relatively minor complaints in a large proportion of patients. 109 (89%) out of 123 lateral arm flaps performed over a seven-year period were reviewed an average of three years after surgery. Unsatisfactory appearance of the donor site was noted by 27% of patients and was twice as likely to be reported by female patients and in cases in which the donor site was repaired by a split-thickness skin graft rather than by primary closure. Elbow pain was reported by 19%. Numbness in the forearm was reported by 59% and was unchanged during the follow-up period in the majority of patients. 17% of patients noted hypersensitivity of the donor site to a variety of stimuli such as cold or vibration. Hair formation was reported at the recipient site by 78% of patients. 83% of the patients found the flap to be bulky and 15% had undergone at least one procedure for debulking. We recommend that the use of the lateral arm flap should be limited to males and cases in which the resulting donor site can be closed primarily.

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Primary Closure of Split-Thickness Skin Graft Donor Site

Innovative Techniques in Skin Surgery ◽

10.1201/b14063-74 ◽

2002 ◽

pp. 457-460

Author(s):

Alfred Sofer ◽

Richard Hagerty

Keyword(s):

Skin Graft ◽

Primary Closure ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor

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Modification of Split-Thickness Skin Graft: Cosmetic Donor Site and Better Recipient Site

Annals of Plastic Surgery ◽

10.1097/01.sap.0000029632.62669.ce ◽

2003 ◽

Vol 50 (2) ◽

pp. 212-214 ◽

Cited By ~ 19

Author(s):

Tiem Chuenkongkaew

Keyword(s):

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Recipient Site ◽

Thickness Skin

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Advances in the use of electrospun nanofibrous polymeric matrix for dermal healing at the donor site after the split-thickness skin graft excision: a prospective, randomized, controlled, open-label, multicenter study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab216 ◽

2021 ◽

Author(s):

Josef Haik ◽

Yehuda Ullman ◽

Eyal Gur ◽

Dean Ad-El ◽

Dana Egozi ◽

...

Keyword(s):

Adverse Events ◽

Skin Graft ◽

Wound Care ◽

Donor Site ◽

Control Group ◽

Split Thickness Skin Graft ◽

Open Label ◽

Thickness Skin ◽

And Control

Abstract Dressings used to manage donor site wounds have up to 40% of patients experiencing complications that may cause suboptimal scarring. We evaluated the efficacy and safety of a portable electrospun nanofibrous matrix that provides contactless management of donor site wounds compared with standard dressing techniques. This study included adult patients who underwent an excised split-thickness skin graft with a donor site wound area of 10-200 cm 2. Patients were allocated into two groups; i.e., the nanofiber group managed with a nanofibrous polymer-based matrix, and the control group managed using the standard of care such as Jelonet® or Biatain® Ibu dressing. Primary outcomes were postoperative dermal healing efficacy assessed by Draize scores. The time to complete re-epithelialization was also recorded. Secondary outcomes included postoperative adverse events, pain, and infections during the first 21-days and extended 12-month follow-up. The itching and scarring were recorded during the extended follow-up (months 1,3,6,9,12) using Numerical-Analogue-Score and Vancouver scores, respectively. The nanofiber and control groups included 21 and 20 patients, respectively. The Draize dermal irritation scores were significantly lower in the nanofiber vs. control group (Z=-2.509; P=0.028) on the first postoperative day but became similar afterward (Z≥-1.62; P≥0.198). In addition, the average time to re-epithelialization was similar in the nanofiber (17.9±4.4 days) and control group (18.3±4.5 days) (Z=-0.299; P=0.764), so were postoperative adverse events, pain, and infection incidence, itching and scarring. The safety and efficacy of electrospun nanofibrous matrix are similar to standard wound care allowing its use as an alternative donor site dressing following the split-thickness skin graft excision.

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Feasibility and Advantages of Full Thickness Skin Graft from the Anterolateral Thigh

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500563 ◽

2017 ◽

Vol 22 (04) ◽

pp. 497-502 ◽

Cited By ~ 2

Author(s):

Seung-Han Shin ◽

Chulkyu Kim ◽

Yong-Suk Lee ◽

Jin-Woo Kang ◽

Yang-Guk Chung

Keyword(s):

Skin Graft ◽

Donor Site ◽

Full Thickness ◽

Full Thickness Skin Graft ◽

Recipient Site ◽

Full Thickness Skin ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Patient Reported

Background: Full thickness skin graft (FTSG) gives better outcomes than split thickness skin graft (STSG), but it has the drawback of limited donor sites. Anterolateral thigh (ALT), a popular donor site of STSG, is also a popular donor site of perforator flaps. This area has the advantage of large flap size available with primary closure. Based on this we harvested FTSG instead of STSG from the ALT. Methods: We retrospectively reviewed 10 cases of FTSG from the ALT, with the recipient site of foot in 3, ankle in 2, lower leg in 2, forearm in 2, and wrist in 1 patient. In all cases elliptical full thickness skin was harvested from the ALT, and the donor site was closed primarily. The skin was defatted and placed onto the defect with vacuum-assisted closure (VAC). The skin size ranged 7-30 cm in length and 3–12 cm in width. Mean follow up period was 7 months (range, 3–13). Results: FTSG from the ALT provided durable wound coverage, with excellent color and texture matching. Partial (< 20%) graft failure was observed in 1 case, but no additional surgery was necessary. No patient reported donor site pain at postoperative 2 weeks. No donor site complications were encountered. No patient complained a feeling of tension in the thigh at final follow-up. Conclusions: FTSG from the ALT is feasible with the aid of VAC. Considering the skin quality, large skin size available, early pain relief, and little donor site morbidity, the ALT should be revisited as a donor site of FTSG.

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Primary Closure of Split-Thickness Skin Graft Donor Site

Innovative Techniques in Skin Surgery ◽

10.3109/9780203909065-76 ◽

2002 ◽

pp. 483-486

Keyword(s):

Skin Graft ◽

Primary Closure ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor

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Tumescent non-tumescent technique for split thickness skin graft harvesting

International Surgery Journal ◽

10.18203/2349-2902.isj20185038 ◽

2018 ◽

Vol 5 (12) ◽

pp. 4026

Author(s):

M. K. Rajendran

Keyword(s):

Blood Loss ◽

Skin Graft ◽

Donor Site ◽

Skin Grafting ◽

Split Thickness Skin Graft ◽

Skin Grafts ◽

Recipient Site ◽

Tumescent Technique ◽

Graft Take ◽

Thickness Skin

Background: Split-thickness skin graft failures can be attributed to flaws in the recipient bed which has to be well prepared. Tissues with limited blood supply such as bone, tendons, cartilage or sites with necrotic tissue or infection do not accept skin grafts. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. The aim of our study was to determine skin graft take after tumescent technique compared to a non-tumescent technique for harvesting.Methods: Two treatment groups of patients who fulfilled the inclusion criteria were randomly assigned. Forty patients underwent split-thickness skin graft harvesting with tumescent technique and forty patients underwent non-tumescent split-thickness skin graft harvesting. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. The donor site was assessed on day ten and if not healed, followed up for three weeks.Results: There was a statistically significant association between skin graft take rate and skin grafting technique (p=0.011). The mean graft take rate was 2.5% higher in the tumescent group compared to the non-tumescent group (96.3% compared to 94%). On day 10, there was no difference in percentage healing of donor sites between the tumescent and non-tumescent groups, p=0.562.Conclusions: Tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal adrenaline/saline injection creates a smooth, dense surface which assists debridement and donor harvesting.

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Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1718550 ◽

2020 ◽

Author(s):

Domenico Pagliara ◽

Maria Lucia Mangialardi ◽

Stefano Vitagliano ◽

Valentina Pino ◽

Marzia Salgarello

Keyword(s):

Comparative Study ◽

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Tactile Sensitivity ◽

Aesthetic Outcome ◽

Propeller Flap ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

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Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽

10.1186/s12893-021-01056-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Lu ◽

Ke-Chung Chang ◽

Che-Ning Chang ◽

Dun-Hao Chang

Keyword(s):

Skin Graft ◽

Subcutaneous Tissue ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Salvage Procedure ◽

Primary Defect ◽

Scalp Defects ◽

Thickness Skin ◽

Scalp Defect ◽

Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

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