Maxillofacial Plastic and Reconstructive Surgery

  • Volume 37
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  • Pages.45.1-45.8
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  • 2015
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  • 2288-8101(pISSN)
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  • 2288-8586(eISSN)
Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Double-layered collagen graft to the radial forearm free flap donor sites without skin graft

  • Park, Tae-Jun (Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Seoul Asan Medical Center) ;
  • Kim, Hong-Joon (Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Seoul Asan Medical Center) ;
  • Ahn, Kang-Min (Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Seoul Asan Medical Center)
  • Received : 2015.10.12
  • Accepted : 2015.11.17
  • Published : 2015.12.31
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Abstract

Background: Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft. Methods: Twenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27-84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated. Results: An average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer. Conclusions: Double-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.

Keywords

References

  1. Urken ML, Weinberg H, Vickery C, Biller HF (1990) The neurofasciocutaneous radial forearm flap in head and neck reconstruction: a preliminary report. Laryngoscope 100:161-73
  2. Lee J, Seo K (1991) The orofacial reconstruction using free radial forearm flap; the experience of 12 consecutive forearm flaps. Maxillofac Plast Reconstr Surg 13:305-18
  3. Kim N, Seo D, Park S, Kim H, Cha I, Nam W (2008) Availability of radial forearm free flap in reconstruction of intraoral soft tissue defects: review of 50 cases. Maxillofac Plast Reconstr Surg 30:353-8
  4. Richardson D, Fisher SE, Vaughan ED, Brown JS (1997) Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg 99:109-15 https://doi.org/10.1097/00006534-199701000-00017
  5. Rowe NM, Morris L, Delacure MD (2006) Acellular dermal composite allografts for reconstruction of the radial forearm donor site. Ann Plast Surg 57:305-11 https://doi.org/10.1097/01.sap.0000221622.41450.60
  6. Ho T, Couch M, Carson K, Schimberg A, Manley K, Byrne PJ (2006) Radial forearm free flap donor site outcomes comparison by closure methods. Otolaryngol Head Neck Surg 134:309-15 https://doi.org/10.1016/j.otohns.2005.09.019
  7. Min JH, Yun IS, Lew DH, Roh TS, Lee WJ (2014) The use of matriderm and autologous skin graft in the treatment of full thickness skin defects. Arch Plast Surg 41:330-6 https://doi.org/10.5999/aps.2014.41.4.330
  8. Davis WJ 3rd, Wu C, Sieber D, Vandevender DK (2011) A comparison of full and split thickness skin grafts in radial forearm donor sites. J Hand Microsurg 3:18-24 https://doi.org/10.1007/s12593-011-0036-9
  9. Wester JL, Pittman AL, Lindau RH, Wax MK (2014) AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg 150:47-52 https://doi.org/10.1177/0194599813513713
  10. Wirthmann A, Finke JC, Giovanoli P, Lindenblatt N (2014) Long-term follow-up of donor site morbidity after defect coverage with Integra following radial forearm flap elevation. Eur J Plast Surg 37:159-66 https://doi.org/10.1007/s00238-013-0918-0
  11. Ito O, Igawa HH, Suzuki S, Muneuchi G, Kawazoe T, Saso Y et al (2005) Evaluation of the donor site in patients who underwent reconstruction with a free radial forearm flap. J Reconstr Microsurg 21:113-7 https://doi.org/10.1055/s-2005-864844
  12. Hur GY, Seo DK, Lee JW (2014) Contracture of skin graft in human burns: effect of artificial dermis. Burns 40:1497-503 https://doi.org/10.1016/j.burns.2014.08.007
  13. Bessho K, Murakami K, Iizuka T (1998) The use of a new bilayer artificial dermis for vestibular extension. Br J Oral Maxillofac Surg 36:457-9 https://doi.org/10.1016/S0266-4356(98)90463-6
  14. Koide M, Osaki K, Konishi J, Oyamada K, Katakura T, Takahashi A et al (1993) A new type of biomaterial for artificial skin: dehydrothermally cross-linked composites of fibrillar and denatured collagens. J Biomed Mater Res 27:79-87 https://doi.org/10.1002/jbm.820270111
  15. Fujioka M (2009) Artificial dermis: a new material for wound treatment. Journal of wound technology 4:13-9
  16. Nakanishi A, Hakamada A, Isoda K, Mizutani H (2005) Atelocollagen sponge and recombinant basic fibroblast growth factor combination therapy for resistant wounds with deep cavities. J Dermatol 32:376-80 https://doi.org/10.1111/j.1346-8138.2005.tb00910.x
  17. Ohno S, Hirano S, Tateya I, Kanemaru S, Umeda H, Suehiro A et al (2009) Atelocollagen sponge as a stem cell implantation scaffold for the treatment of scarred vocal folds. Ann Otol Rhinol Laryngol 118:805-10 https://doi.org/10.1177/000348940911801110
  18. Choi JY, Kim SH, Oh GJ, Roh SG, Lee NH, Yang KM (2014) Management of defects on lower extremities with the use of matriderm and skin graft. Arch Plast Surg 41:337-43 https://doi.org/10.5999/aps.2014.41.4.337
  19. Middelkoop E, de Vries HJ, Ruuls L, Everts V, Wildevuur CH, Westerhof W (1995) Adherence, proliferation and collagen turnover by human fibroblasts seeded into different types of collagen sponges. Cell Tissue Res 280:447-53 https://doi.org/10.1007/BF00307818
  20. Lamme EN, van Leeuwen RT, Jonker A, van Marle J, Middelkoop E (1998) Living skin substitutes: survival and function of fibroblasts seeded in a dermal substitute in experimental wounds. J Invest Dermatol 111:989-95 https://doi.org/10.1046/j.1523-1747.1998.00459.x
  21. Ryssel H, Radu CA, Germann G, Otte M, Gazyakan E (2010) Single-stage Matriderm (R) and skin grafting as an alternative reconstruction in high-voltage injuries. Int Wound J 7:385-92 https://doi.org/10.1111/j.1742-481X.2010.00703.x
  22. Wax MK, Winslow CP, Andersen PE (2002) Use of allogenic dermis for radial forearm free flap donor site coverage. J Otolaryngol 31:341-5 https://doi.org/10.2310/7070.2002.34423

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