title: Cosmetic and functional outcomes after preoperative tissue expansion of radial forearm free flap donor sites: a cohort study.
abstract: BACKGROUND
  The use of the DynaClose topical tissue expansion device for closure of radial forearm free flap (RFFF) donor sites has been demonstrated to significantly reduce healing time and postoperative pain compared to the traditional use of a split-thickness skin graft. However, long-term cosmetic and functional outcomes are not known.
  
  
  OBJECTIVE
  The objective of this study was to test the hypothesis that using a new method of donor site management will result in improved cosmesis of RFFF donor sites as assessed by both patients and expert observers without resulting in a reduction in the function of the patients' forearm.
  
  
  METHODS
  A cohort of 25 patients previously randomized to either the treatment (tissue expansion) or the control group were assessed at 10 months. The Patient and Observer Scar Assessment Scale (PAOSAS) was used to assess forearm scars, whereas the Michigan Hand Outcomes Questionnaire assessed hand function.
  
  
  RESULTS
  Expert observers noted improved scar cosmesis in the treatment group (p  =  .013), with primary closure having the best cosmetic outcome, followed by local full-thickness skin graft closure (p < .001). There was no statistically significant improvement in cosmesis as assessed by patients (p  =  .03) or differences in Michigan Hand Outcomes Questionnaire scores between treatment groups (p  =  .57).
  
  
  CONCLUSIONS
  Using an inexpensive, noninvasive preoperative tissue expansion device safely results in improved cosmetic outcomes as assessed by expert observers, without any significant functional forearm and hand deficits.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, The University of Ottawa, Ottawa, ON. jbonapar@dal.ca
authors.forename: James P
authors.initials: JP
authors.lastname: Bonaparte
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Corsten
authors.forename: Murray
authors.initials: M
authors.lastname: Allen
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000175:diagnosis; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009864:Ontario; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis*; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D015625:Tissue Expansion Devices; D020858:Tissue and Organ Harvesting; D060053:Transplant Donor Site