Page 73 - Read Online

a combined local triangular full-thickness skin graft. Color match, quality of the scar, presence
of necrosis, dehiscence of the suture or tendon exposure were recorded and analyzed. Results:
One hundred and twenty-five consecutive patients undergoing RFFF harvesting were included.
2
2
RFFF donor site defects ranged from 15 cm to 70 cm ; 9 patients (7%) had small dehiscences of
the forearm skin graft, whereas 2 cases (1.6%) presented tendon exposure. Otherwise, partial skin
graft loss occurred in a few patients. In all cases, these sites healed secondarily by conservative
management, with no final impairment of function. Assessment of the forearm donor site at 1
to 3 months after the primary surgical procedure showed complete defect coverage, good color
match, and no scarring along the graft line. Conclusion: The “Iberic graft” is a reliable method
for closing most of RFFF donor site defects as it provides excellent color match and pliability,
while obviates the need for a second surgical site.

Key words:
Radial forearm free flap; donor site morbidity; full-thickness skin graft; “Iberic graft”

INTRODUCTION article, we analyzed the results (esthetics and function)
using the Iberic graft.
[1]
Since its introduction in 1981 by Yang et al. the radial
forearm free flap (RFFF) has been used extensively for METHODS
reconstruction of head and neck defects after oncologic
[27]
resection. However, many donor site complications have As described by González-García et al., the design of
been described, such as partial loss of the skin graft, the RFFF begins by outlining the course of the dominant
sensory disturbance, tendon exposure, and esthetic subcutaneous veins and the palpable pulse of the radial
pitfalls. [2-5] Direct closure is not often possible due to too- artery. The flap is elevated in a subfascial layer in a few
large defects or insufficient skin laxity. [6-8] cases and in a supra-fascial layer in other cases. The
superficial branch of the radial nerve is preserved in all
Several techniques have been described for adequate cases. The basis for the design of the Iberic graft is the
closure of the donor site defect after RFFF harvesting, geometric concept of the designed skin paddle and the
such as purse-string closure, split-thickness skin grafts local FTSGs. Thus, a quadrangular or rectangular radial
[9]
(STSGs), [10,11] full-thickness skin grafts (FTSGs), [12-15] forearm flap is outlined on the distal forearm. A double
tissue expansion, [16,17] closure with local flaps, [18-20] cross- curvilinear line is outlined from the proximal portion of
suturing, use of artificial dermis, [22,23] and local fascial the RFFF to the proximal forearm to provide Access to the
[21]
flaps. STSGs are most commonly used. FTSGs can proximal portion of the neurovascular pedicle; this double
[24]
be used to provide a thicker coverage of the defect; curvilinear line allows the design of 2 opposed arcs. Then,
they are more resistant to contractures or trauma and 2 bowstrings are outlined within the concavities of the
provide better esthetics results. However, their main arcs. At the midpoint of each bowstring, a perpendicular
disadvantages are potential increased morbidity and dotted line is outlined to the midpoint of each arc. This
occasional need for an STSG to close the second donor perpendicular dotted line is half the width of the RFFF
site. Those patients in whom the skin graft is harvested donor defect and no longer than 3.5 cm to allow direct
[25]
from the thigh can develop several other complications, closure of the forearm skin flaps. At this point, 4 isosceles
such as pain, infection, and hypertrophic scar formation. triangles are depicted [Figure 1]. Subsequent triangular
Moreover, evident color mismatch is often present in FTSGs are harvested and freed from the forearm. Silk
relation to the surrounding forearm skin. In addition, sutures are used to join the FTSGs to the borders of the
[26]
avoiding a second surgical site might be a valuable aspect defect and resorbable sutures are used to join 1 skin
to consider to decrease postoperative complication rates. triangle to another. Then, the FTSGs are covered with a
sponge using a tie-bolster technique and dressed with
To avoid complications at the donor site from RFFF regular gauzes with nitrofuran (Furacin 2 mg/g; LAB-
®
harvesting, such as color mismatch and secondary donor SEID , Barcelona, Spain) and protected in a forearm
®
site morbidity, a new technique named ‘‘Iberic graft’’ splint for 10 days.
for covering the RFFF donor site based on the use of
combined local FTSG triangles within a geometric model RESULTS
concept was described by the authors’ group in 2009. [27]
One hundred and twenty-five consecutive patients
Since its description, we have used this technique for underwent RFFF harvesting for head and neck
covering the RFFF donor site in 125 patients. In this reconstruction since the first case. Primary closure of
198 Plast Aesthet Res || Volume 3 || June 24, 2016