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Optimal treatment of the radial forearm flap donor site remains a difficult clinical problem, with complications including unsightly scarring, tendon exposure, and impaired range of motion and strength. Integra artificial dermal matrix has been described as an alternative to autograft alone for the reconstruction of these donor site defects using a two-stage process. This study is a retrospective review of a consecutive series of radial forearm flap donor sites that have been treated with monolayer Integra artificial dermal matrix and autograft in a single stage. Methods: Fourteen consecutive cases of radial forearm free flaps performed between June 2011 and June 2013 were reviewed. In each case, the donor site was reconstructed using monolayer Integra artificial dermal matrix and autograft in a single stage. After routine harvest of the flap, monolayer Integra artificial dermal matrix was meshed and applied to the wound. A splitthickness skin graft was then harvested and either meshed or pie-crusted prior to application over the Integra. A negative pressure wound dressing was applied over the grafts for 5-7 days. The donor site was evaluated with regards to skin graft take, scar appearance, strength and range of motion, paresthesias, infection, and the need for secondary interventions. Results: The fourteen patients had a mean age of 53 years old (range 20-68) and radial forearm donor site defect area of 65 cm (range 30-110 cm). Follow up time ranged from four to 18 months. All defects had >98% skin graft take. There were no infections, and no patients required secondary intervention. Hypertrophic scarring was not seen in any patient, although 2/14 patients had some degree of scar hypopigmentation. 2/14 patients had FCR tendon exposure of <0.5 cm. 2/14 had diminished grip strength as compared with the normal contralateral side. 4/14 patients had paresthesias in the early postoperative period, all of which resolved by 4 weeks. Conclusions: Treatment of the radial forearm flap donor site using Integra artificial dermal matrix and autograft is a promising alternative to autograft alone and is possible in a single stage. References: 1. Gravvanis AI, Tsoutsos DA, Iconomou T, Gremoutis G: The use of integra artificial dermis to minimize donor-site morbidity after suprafascial dissection of the radial forearm flap; Microsurgery; 27: 583-7; 2007. 2. Murray RC, Gordin EA, Saigal K, Leventhal D, Krein H, Heffelfinger RN: Reconstruction of the radial forearm free flap donor site using integra artificial dermis; Microsurgery; 31(2): 104-8; 2011. Disclosure: None of the authors has a financial interest in any of the products mentioned in this manuscript.

Treatment of the Radial Forearm Flap Donor Site with Single-Stage Integra™ Artificial Dermal Matrix and Autograft