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Management of the Radial Forearm Free Flap Donor Site With the Vacuum-Assisted Closure (VAC) System

Authors

  • Brian T. Andrews MD,

    1. University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Iowa City, Iowa, U.S.A.
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  • Russell B. Smith MD,

    1. University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Iowa City, Iowa, U.S.A.
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  • Kristi E. Chang MD,

    1. University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Iowa City, Iowa, U.S.A.
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  • Joseph Scharpf MD,

    1. University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Iowa City, Iowa, U.S.A.
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  • David P. Goldstein MD,

    1. University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Iowa City, Iowa, U.S.A.
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  • Gerry F. Funk MD

    Corresponding author
    1. University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Iowa City, Iowa, U.S.A.
    • Gerry F. Funk, MD, University of Iowa College of Medicine, Department of Otolaryngology–Head and Neck Surgery, 21272 Pomerantz Pavillion, 200 Hawkins Dr., Iowa City, IA 52242, U.S.A.
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Abstract

Introduction: 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.

Conclusion: 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.

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