Management of the radial forearm free flap donor site with the vacuum-assisted closure (VAC) system.
BACKGROUND
The radial forearm free flap is a popular reconstructive flap in modern head and neck surgery. Poor wound healing at the forearm donor site is common and frequently results in tendon exposure. The Vacuum-Assisted Closure (VAC) system (Kinetic Concepts Inc., San Antonio, TX) is a topical negative pressure dressing that has been shown to improve skin graft viability when used as a bolster dressing. In this study, we investigated the use of the VAC system in the management of the radial forearm free flap donor site.


METHODS
A retrospective chart review was performed on all subjects who underwent a radial forearm free flap reconstruction in which the VAC system was used as a bolster dressing at the donor site from January 1, 2003, through March 31, 2005.


RESULTS
Thirty-four consecutive subjects were included in the study. Exposed tendon did not occur in 14 (0%) subjects in which the VAC bolster was used for a minimum of 6 days. Eleven of the 20 subjects (55%) who used the VAC bolster for 5 days demonstrated small amounts of tendon exposure (<2 cm) on follow-up clinic examination. The minimum follow up for all subjects was 4 months.


CONCLUSIONS
This study demonstrates that the VAC system is a feasible alternative to conventional bolster dressing in the management of the radial forearm free flap skin-grafted donor site. Based on this study, when used for a minimum of 6 days, the VAC bolster dressing eliminated tendon exposure at the forearm donor site.
Andrews
Brian T
BT
University of Iowa College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Iowa City, Iowa, USA. gerry-funk@uiowa.edu
Smith
Russell B
RB
Chang
Kristi E
KE
Scharpf
Joseph
J
Goldstein
David P
DP
Funk
Gerry F
GF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery*; D006097:Granulation Tissue / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings / Q000145:classification*; D011183:Postoperative Complications / Q000517:prevention & control; D011312:Pressure; D011884:Radius / Q000601:surgery*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps; D013710:Tendons / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology