Improvement of the radial forearm donor site by prefabrication of fascial-split-thickness skin grafts

A basic disadvantage of radial forearm flaps is the removal of skin from a functionally important and cosmetically exposed region. To minimize the donor-site morbidity of the radial forearm flap, we have thus far used a two- phase procedure for intraoral defect coverage in five patients: In a first step, a split-thickness skin graft is transplanted to the forearm fascia, which 'takes' there over a period of 2 weeks. In step two, the prefabricated fascial-split-thickness skin flap can be raised with complete preservation of the forearm skin and microsurgically transplanted like a conventional radial flap. Performing this procedure, we have obtained the following results: (1) All skin grafts 'took' completely on the forearm fascia. (2) Prefabricated fascial-split-thickness skin flaps could be raised without any problems, like conventional radial forearm flaps. (3) All flaps were excellently suited for defect coverage in the oral cavity as very thin and moldable grafts and 'took' without any complications. (4) Tension-free primary closure of all forearm donor sits was achieved with only slight cosmetic and functional impairment.