title: Free Flap Donor Site Reconstruction: A Prospective Case Series Using an Optimized Polyurethane Biodegradable Temporizing Matrix.
abstract: BACKGROUND
  We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable polyurethane matrix (to form a neodermis), followed by definitive closure with an autologous split-skin graft. Two issues were revealed by this pilot study that led to further modification of the biodegradable temporizing matrix. This involved alterations to the seal thickness and bonding to the foam matrix and the introduction of fenestrations to the seal.
  
  
  OBJECTIVE
  This article documents a second cohort of patients requiring free flap (fibular and radial forearm) donor site reconstruction with this optimized material.
  
  
  METHODS
  The biodegradable temporizing matrix was implanted when the free flap was detached from its donor site. Subsequent integration was monitored closely. Five weeks was the usual time of integration before delamination (seal removal), dermabrasion, and definitive closure with autograft.
  
  
  RESULTS
  Integration was complete and uncomplicated in every case, delamination occurred in 1 piece in 1 action, and subsequent graft take was 100% for every patient. Long-term scar outcomes improved compared with the pilot group. Degradation is complete by 12 months, other than occasional microscopic remnants undergoing phagocytosis.
  
  
  CONCLUSIONS
  This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration. No infection was observed, and split-skin overgrafting was successful and uncomplicated.
authors.affiliation: Adult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia ; Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Marcus J D
authors.initials: MJ
authors.lastname: Wagstaff
authors.affiliation: Adult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Schmitt
authors.affiliation: Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Yugesh
authors.initials: Y
authors.lastname: Caplash
authors.affiliation: Adult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: John E
authors.initials: JE
authors.lastname: Greenwood
keywords: biodegradable polyurethane; dermal scaffold; free flap donor site; reconstruction; synthetic dermal matrix