Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy

Jessica M Clark; Shannon Rychlik; Jeffrey Harris; Hadi Seikaly; Vincent L Biron; Daniel A O'Connell

doi:10.1186/s40463-019-0344-9

Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy

J Otolaryngol Head Neck Surg. 2019 May 21;48(1):21. doi: 10.1186/s40463-019-0344-9.

Authors

Jessica M Clark¹, Shannon Rychlik¹, Jeffrey Harris^{1

2}, Hadi Seikaly^{1

2}, Vincent L Biron^{1

2}, Daniel A O'Connell^{3

4}

Affiliations

¹ Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.
² Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada.
³ Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada. danielo@ualberta.ca.
⁴ Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada. danielo@ualberta.ca.

Abstract

Background: Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD.

Methods: Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications.

Results: Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively (P = 0.016). Flexion at seven days was improved in NPD group (P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation.

Conclusions: In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.

Keywords: Hand; Negative pressure wound therapy; Patient-reported outcomes; Radial forearm free flap; Split thickness skin graft; Wrist.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Cicatrix
Compression Bandages*
Esthetics
Female
Forearm / surgery*
Free Tissue Flaps*
Humans
Male
Middle Aged
Negative-Pressure Wound Therapy*
Patient Reported Outcome Measures
Plastic Surgery Procedures* / adverse effects
Recovery of Function
Skin Transplantation