Treatment of the Radial Forearm Flap Donor Site with Single-Stage IntegraTM Artificial Dermal Matrix and Autograft

Introduction:  Optimal treatment of the radial forearm flap donor site remains a difficult clinical problem, with complications including unsightly scarring, tendon exposure, and impaired range of motion and strength.  Integra^TM artificial dermal matrix has been described as an alternative to autograft alone for the reconstruction of these donor site defects using a two-stage process^1,2.  This study is a retrospective review of a consecutive series of radial forearm flap donor sites that have been treated with monolayer Integra^TM artificial dermal matrix and autograft in a single stage. 

Methods: Fourteen consecutive cases of radial forearm free flaps performed between June 2011 and June 2013 were reviewed.  In each case, the donor site was reconstructed using monolayer Integra^TM artificial dermal matrix and autograft in a single stage.  After routine harvest of the flap, monolayer Integra^TM artificial dermal matrix was meshed and applied to the wound.  A split-thickness skin graft was then harvested and either meshed or pie-crusted prior to application over the Integra^TM.  A negative pressure wound dressing was applied over the grafts for 5-7 days.  The donor site was evaluated with regards to skin graft take, scar appearance, strength and range of motion, paresthesias, infection, and the need for secondary interventions. 

Results:  The fourteen patients had a mean age of 53 years old (range 20-68) and radial forearm donor site defect area of 65 cm² (range 30-110 cm²).  Follow up time ranged from four to 18 months.  All defects had >98% skin graft take.  There were no infections, and no patients required secondary intervention.  Hypertrophic scarring was not seen in any patient, although 2/14 patients had some degree of scar hypopigmentation.  2/14 patients had FCR tendon exposure of <0.5 cm².  2/14 had diminished grip strength as compared with the normal contralateral side.  4/14 patients had paresthesias in the early postoperative period, all of which resolved by 4 weeks. 

Conclusions: Treatment of the radial forearm flap donor site using Integra^TM artificial dermal matrix and autograft is a promising alternative to autograft alone and is possible in a single stage.