摘要：Aim:Free tissue transfer is essential for extremity reconstruction following traumatic injuries,oncologic resection,and diabetic complications.However,given the circumferential shape of the arm and leg,a small amount of ongoing edema can prevent a tension-free closure.Additionally,intraoperative thrombosis,vascular disease can lead to proximal exposure of the pedicle or vein grafts.This study evaluates the outcomes of microvascular transfers that utilized a skin graft for closure over the pedicle,in comparison with a matched cohort with a tension-free primary closure.Methods:A retrospective review was completed of all patients that underwent free flap reconstruction of an extremity defect from January 2014 to December 2017 at a single academic institution.Flaps that utilized skin grafting for closure were compared to those closed primarily.Adjunct operative procedures,demographics,and complications were evaluated.Results:A total of 71 patients fulfilled the inclusion criteria.The 11 flaps in 10 patients underwent skin grafting over the pedicle.The two cohorts were comparable in age,gender,BMI,and co-morbidities,excluding renal disease which was present in 40%(n=4)of skin grafted group compared to 6.5%(n=4)in the primary closure group.Flap area,operative time,and anastomosis technique were comparable between the two groups.There was no significant difference in the rates of post-operative complications including partial flap loss,complete flap loss,infection.Mean follow up time in the skin grafting group was 14.2 months and 20.2 months for the primary closure group. ;Conclusion:As per the principal,a tension-free closure is paramount to preventing tissue complications including direct compression of a microvascular pedicle.However,with ongoing tissue edema skin grafting should be considered as a reliable technique to ensure both protection of the pedicle as well as prevention of direct compression without additional complications and comparable post-operative outcomes.
