Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA.
Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Medical Branch, Galveston, Texas, USA.
Microsurgery. 2024 Jan;44(1):e31126. doi: 10.1002/micr.31126. Epub 2023 Nov 22.
Radial forearm free flap (RFFF) donor site closure is traditionally performed with split thickness skin grafts (STSG), which can be associated with poor aesthetics, wrist stiffness, paresthesia, reduced strength, and tendon exposure. Full thickness skin grafts (FTSG) are potentially beneficial as they provide a more durable coverage, and the skin graft donor site can be closed primarily, which is more aesthetic. The aim of this systematic review is to compare the outcomes of STSG versus FTSG for closure of the RFFF donor site.
A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary objective was to answer: do subjects undergoing RFFF harvest, utilizing FTSG to close the RFFF donor site, compared to STSG, achieve superior aesthetics at the RFFF donor site? Included papers compared FTSG and STSG with statistical data. Means were compared with t-test and proportions with Fisher's exact test.
The initial search resulted in 1851 studies. After applying the inclusion/exclusion criteria, the search resulted in eight studies, with 366 total skin grafts, 197 STSG and 169 FTSG. Six studies evaluated aesthetics utilizing a Likert scale, with the scaled average aesthetic score for FTSG being 7.9/10 compared to 6.9/10 for STSG (p < .001). Tendon exposure was measured in five studies, with a rate of 13.1% for STSG versus 10.6% for FTSG (p = .555). No significant difference in function was observed, however, methods to quantify function were heterogeneous.
FTSG compared to STSG, resulted in statistically significant improved aesthetics, with comparable rates of tendon exposure and function.
桡侧前臂游离皮瓣（RFFF）供区的传统关闭方法是使用中厚皮片（STSG），但可能会导致外观不佳、腕部僵硬、感觉异常、力量减弱和肌腱外露。全厚皮片（FTSG）可能更有益，因为它们提供了更持久的覆盖，并且皮片供区可以直接闭合，更美观。本系统评价的目的是比较 STSG 与 FTSG 闭合 RFFF 供区的效果。
按照系统评价和荟萃分析报告的首选条目进行系统评价。主要目的是回答：与 STSG 相比，接受 RFFF 采集的患者，使用 FTSG 闭合 RFFF 供区，在 RFFF 供区的美学效果是否更好？纳入的文献比较了 FTSG 和 STSG，并提供了统计数据。均值采用 t 检验比较，比例采用 Fisher 精确检验比较。
最初的搜索结果有 1851 项研究。经过纳入/排除标准后，搜索结果有 8 项研究，共 366 例皮片移植，其中 197 例采用 STSG，169 例采用 FTSG。6 项研究采用 Likert 量表评估美学效果，FTSG 的平均美学评分 7.9/10，而 STSG 为 6.9/10（p<0.001）。5 项研究测量了肌腱外露情况，STSG 的肌腱外露率为 13.1%，FTSG 为 10.6%（p=0.555）。虽然功能没有显著差异，但功能量化的方法存在差异。
与 STSG 相比，FTSG 可显著改善美学效果，肌腱外露和功能的发生率相似。
