Evaluation of the Advantages of Integra® (Dermal Matrix) for Covering the Radial Flap Donor Site: Ten Cases

Primary closure of the donor site following harvesting of a radial forearm flap is not always possible. In these cases, a thin skin graft is habitually used. This approach generally results in an ugly scar that adheres to the underlying muscles and tendons.

Between 2001 and 2002, the authors carried out ten radial forearm flap procedures. In all cases, the flexor carpi radialis (FCR), palmaris longus (PL), and brachioradialis (BR) tendons were exposed. A total of 10 patients were included (7 men and 3 women) with a mean age of 46.5 years (range: 25 to 77 years). In all patients, the donor site was covered with Integra®. The cosmetic results of healing were then evaluated by the patients and by a physician not involved in the actual surgical procedure. Scores were on a scale of 1 (ugly scar) to 10 (perfect healing). The area of healing (grafted with Integra®) was considered free of adhesion, if the examiner could create a skin fold and where passive and active mobilization of the wrist in flexion/extension did not result in concomitant mobilization of the adjacent area of healing.

Integra® took successfully in 9 cases. One failure was seen in a smoker with poor discipline who failed to return for bandaging. In addition, this patient was lost to follow-up. In two patients, further epidermal grafting was required due to partial failure of the initial graft. For the 9 patients seen again, time to assessment was 12.7 months. Mean time to wound healing was 4.8 weeks (range: 4 to 7 weeks). In cosmetic terms, the mean scores were 8.9 by patients and 7.3 by physicians. There was no discomfort on mobilization of the wrist and the amplitude of movement was identical to that seen in the non-operated contralateral wrist. No adhesion was seen in any of the patients between the flap donor site covered with Integra® and the underlying layer. In the series, the mean healing time was 4.8 weeks, which is relatively short.

In view of the results obtained in the series, the use of Integra® in covering radial forearm donor sites is of some value.