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Figure 7: Good color match three months after surgery
recipient vessels are in the neck (it is not possible to use
when anastomosis is performed with temporal vessels in
Figure 5: Good color match and esthetic outcome six months after non-oncologic patients). In the authors’ opinion, another
surgery
drawback with the use of an FTSG from the arm or neck
for RFFF donor site reconstruction is the color mismatch
in relation to the forearm skin. Several investigators
have reported good results in associated morbidity for
the RFFF donor site. [8,29,37,38] However, some reported
methods for covering a donor site defect are limited by
the size of the defect.

[39]
As we described in the first 100 cases, the Iberic
graft technique using 2, 3, or 4 local FTSG triangles
facilitates the development of a geometricmodel for the
Figure 6: Good color match and esthetic outcome two months after reconstruction of large RFFF donor site defects (70 to
surgery
80 cm ), because the alignment of triangles with bases
2
FTSGs harvested from the abdomen for donor site measuring up to 3.5 cm covers defects up to 7 cm wide.
closure have been used and several complications have The length of the defect is not usually a problem, because
been observed, including hematomas, postoperative defects up to 10 cm in length can be easily covered by
pain, delayed healing, poor esthetic results, and the triangles measuring up to 5 cm in height, without the
need for a second surgical site. An FTSG from the need for additional extension of the forearm incision. A
[27]
inner arm has been used by other investigators, but they limitation to consider in this technique was related to
claim that additional time for removal of the tourniquet moderate skin laxity of the patients, because most were
and further preparation and draping of the arm are 55 to 60 years old and thus more likely to achieve good
required. [33,34] Other authors have recently reported results in the defect closure than younger patients with
the use of FTSGs harvested from the upper inner arm mild skin laxity. Nonetheless, this surgical technique has
or neck for closure of the RFFF donor site defect, shown optimal results in young patients.
leading to a robust coverage. [35,36] Among 25 RFFFs used During the 7 years since the first description of the
for soft tissue reconstruction, Kaltman et al. found technique in 2009, the Iberic graft technique has
[35]
donor site morbidity in only 1 case, which had a failed been performed by the authors in every single patient
FTSG. They promoted the use of a technique similar undergoing reconstruction with an RFFF. Interestingly,
to the one proposed by Avery et al., which involves there has been an evolution of the adaptation of the skin
[14]
obtaining an FTSG from the inner arm to close the triangles in the donor site defect from a rigid horizontal
defect remaining from the RFFF harvesting. However, disposition of the triangles in the very beginning to a
they also reported wound dehiscence at the medial arm more adaptable and flexible adaptation of the triangle
donor site in 2 patients. Hanna et al., in a series of skin grafts, depending on the size, shape, and contour
[36]
50 patients who underwent RFFF reconstruction with of the donor site defect, including a proximal-to distal
repair of the donor site using an FTSG harvested along disposition of the grafts in the wrist to an oblique or
the neck dissection incision, reported minor skin loss in irregular disposition. This feature also illustrates the
15 cases (30%), which was managed with local wound versatility of this evolving technique for closure of RFFF
care until healing by secondary intention. None of the donor site defects. [40]
patients had recipient site infections. With this method,
the need for this second surgical site was eliminated. In conclusion, the Iberic graft technique is a reliable
However, this technique can be used only when the method for closing RFFF donor site defects because
200 Plast Aesthet Res || Volume 3 || June 24, 2016