PURPOSE: In performing jejunal and ileocolonic flaps for reconstruction of esophagus and voice, it has been common practice to cover the flap with a split-thickness skin graft in a delayed fashion, allowing for swelling of the flap and monitoring. In order to limit the number of repeat visits to the operating room, we have begun to harvest the skin graft at the time of reconstruction and bank it at its donor site for later transfer at bedside.

METHOD: Voice reconstruction using a free jejunal or ileocolic segment was performed in six consecutive patients between January and July of 2006. All patients had skin harvested from their anterior-lateral thigh with an air dermatome at the time of intestinal transfer. The transfer of the STSG from the donor to the recipient site was carried out at bedside between the third and eighth postoperative day with intravenous sedation and analgesia.

RESULTS: The average graft size was 100 sq. cm. The re-harvesting of the STSG took about 3 minutes and the insetting about 10 minutes. The delayed elevation of the STSG from the donor site was uneventful and well tolerated by all patients. The grafts were successfully raised intact and without damage. Skin graft take at the time of discharge was judged clinically as over 95% in all cases. At follow up between 2 and 7 months all grafts had healed. There were no complications related to the skin grafts.

CONCLUSION: We have found delayed skin grafting with autologous banking to be a useful tool for esophageal and voice reconstruction with free intestinal grafts. It not only allows direct observation of the free flap in the early post operative period, but it also restricts the number of operating room trips the patient endures and bypasses the cost of skin banking. This technique has proved to be a reliable method of skin storage which may be applied in diverse clinical situations or where traditional skin banking cannot be performed.