title: The effect of topically applied tissue expanders on radial forearm skin pliability: a prospective self-controlled study.
abstract: BACKGROUND
  The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery.
  
  
  METHODS
  Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant.
  
  
  RESULTS
  There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [-0.04, 0.12], p = 0.30).
  
  
  CONCLUSIONS
  This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.
authors.forename: Jeffson
authors.initials: J
authors.lastname: Chung
authors.forename: James P
authors.initials: JP
authors.lastname: Bonaparte
authors.forename: Michael
authors.initials: M
authors.lastname: Odell
authors.affiliation: The Department of Otolaryngology - Head & Neck Surgery, Ottawa Hospital - General Campus S3, 501 Smyth Road, Ottawa, Ontario K1H 8 L, Canada. mcorsten@ottawahospital.on.ca.
authors.forename: Martin
authors.initials: M
authors.lastname: Corsten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058752:Free Tissue Flaps / Q000502:physiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011300:Preoperative Care; D011446:Prospective Studies; D053832:Surgical Tape; D015626:Tissue Expansion / Q000379:methods*; D060053:Transplant Donor Site / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
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