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Kovar et al. Plast Aesthet Res 2019;6:10 Plastic and
DOI: 10.20517/2347-9264.2019.09 Aesthetic Research

Original Article Open Access

Skin grafting the vascular pedicle: a useful
technique to avoid microvascular collapse in free

tissue transfer for limb salvage

Alexandra Kovar , Shawn Diamond , Matthew L. Iorio 1,2
2
1
1 Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, Aurora, CO 80045, USA.
2 Beth Israel Deaconess Medical Center, Harvard Medical School Plastic Surgery Residency, Boston, MA 02215, USA.

Correspondence to: Dr. Matthew L. Iorio, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical
Center, Mail Stop C309, 12631 East 17th Ave, Room 6619, Aurora, CO 80045, USA. E-mail: matt.iorio@ucdenver.edu

How to cite this article: Kovar A, Diamond S, Iorio ML. Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse
in free tissue transfer for limb salvage. Plast Aesthet Res 2019;6:10. http://dx.doi.org/10.20517/2347-9264.2019.09
Received: 24 Feb 2019 First Decision: 18 Apr 2019 Revised: 1 May 2019 Accepted: 5 May 2019 Published: 23 May 2019

Science Editor: Raúl González-García Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract

Aim: Free tissue transfer is essential for extremity reconstruction following traumatic injuries, oncologic resection,
and diabetic complications. However, given the circumferential shape of the arm and leg, a small amount of ongoing
edema can prevent a tension-free closure. Additionally, intraoperative thrombosis, vascular disease can lead to proximal
exposure of the pedicle or vein grafts. This study evaluates the outcomes of microvascular transfers that utilized a skin
graft for closure over the pedicle, in comparison with a matched cohort with a tension-free primary closure.

Methods: A retrospective review was completed of all patients that underwent free flap reconstruction of an extremity
defect from January 2014 to December 2017 at a single academic institution. Flaps that utilized skin grafting for closure
were compared to those closed primarily. Adjunct operative procedures, demographics, and complications were
evaluated.

Results: A total of 71 patients fulfilled the inclusion criteria. The 11 flaps in 10 patients underwent skin grafting over the
pedicle. The two cohorts were comparable in age, gender, BMI, and co-morbidities, excluding renal disease which was
present in 40% (n = 4) of skin grafted group compared to 6.5% (n = 4) in the primary closure group. Flap area, operative
time, and anastomosis technique were comparable between the two groups. There was no significant difference in the
rates of post-operative complications including partial flap loss, complete flap loss, infection. Mean follow up time in the
skin grafting group was 14.2 months and 20.2 months for the primary closure group.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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