AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site

Jacob L. Wester, Amy L. Pittman, Robert H. Lindau, Mark Wax

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)47-52
Number of pages6
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume150
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Free Tissue Flaps
Forearm
Tissue Donors
Transplants
Skin
Alloderm
Morbidity
Cosmetics
Tendons
Seroma
Paresthesia
Research Ethics Committees
Tertiary Care Centers
Hematoma

Keywords

  • AlloDerm
  • donor site
  • free flap
  • head and neck
  • microvascular
  • radial forearm

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. / Wester, Jacob L.; Pittman, Amy L.; Lindau, Robert H.; Wax, Mark.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 150, No. 1, 01.2014, p. 47-52.

Research output: Contribution to journalArticle

@article{b538245ffcb24a4a98a83120ad828b54,
title = "AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site",
abstract = "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.",
keywords = "AlloDerm, donor site, free flap, head and neck, microvascular, radial forearm",
author = "Wester, {Jacob L.} and Pittman, {Amy L.} and Lindau, {Robert H.} and Mark Wax",
year = "2014",
month = "1",
doi = "10.1177/0194599813513713",
language = "English (US)",
volume = "150",
pages = "47--52",
journal = "Otolaryngology - Head and Neck Surgery (United States)",
issn = "0194-5998",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site

AU - Wester, Jacob L.

AU - Pittman, Amy L.

AU - Lindau, Robert H.

AU - Wax, Mark

PY - 2014/1

Y1 - 2014/1

N2 - 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.

AB - 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.

KW - AlloDerm

KW - donor site

KW - free flap

KW - head and neck

KW - microvascular

KW - radial forearm

UR - http://www.scopus.com/inward/record.url?scp=84890816129&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890816129&partnerID=8YFLogxK

U2 - 10.1177/0194599813513713

DO - 10.1177/0194599813513713

M3 - Article

AN - SCOPUS:84890816129

VL - 150

SP - 47

EP - 52

JO - Otolaryngology - Head and Neck Surgery (United States)

JF - Otolaryngology - Head and Neck Surgery (United States)

SN - 0194-5998

IS - 1

ER -