Evaluation of clinical effect of forearm flap with double thickness skin graft obtained by proximal cardiac step incision for repairing donor site defect

doi:10.19438/j.cjoms.2026.02.010

Abstract

Abstract: PURPOSE: To investigate the feasibility and evaluate the clinical effect of double thickness skin graft obtained by proximal cardiac step incision in repairing the wound of forearm flap donor site. METHODS: From January 2023 to December 2024, 12 patients with oral cancer who required simultaneous forearm flap transplantation after surgery were enrolled in Nanchong Central Hospital. During flap preparation, two full-thickness skin grafts were harvested from the proximal side of the forearm flap using a stepped incision design. After in vitro splicing, the grafts were transplanted to repair the donor site defect. Postoperative follow-up lasted 3-6 months to evaluate donor site healing, complications, and patient satisfaction with aesthetics and function. RESULTS: All 12 patients successfully underwent forearm flap preparation, double full-thickness skin graft harvesting, and in vitro splicing. The donor sites of 11 cases achieved primary closure, and all forearm flaps survived. One skin graft developed necrosis due to excessive suture tension, which healed with scarring after dressing changes; the remaining 11 skin grafts survived completely, with small donor site scars, unimpaired wrist flexion-extension function, and high patient satisfaction. CONCLUSIONS: Stepwise harvesting of full-thickness skin grafts from the proximal forearm flap and splicing for donor site repair can avoid injury to the third surgical area, reduce surgical trauma, and achieve minimally invasive repair of the donor site. It is a feasible solution for the repair of donor site defects of the forearm flap.

Key words: Forearm flap, Donor site repair, Oral cancer, Defect repair, Full-thickness skin graft

CLC Number:

Ming Huawei, He Yun, Yuan Zongyi, Zhang Xing'an, Jia Jiaxin, Chen Fangyuan, Liu Zilong, Tan Xiaoyao. Evaluation of clinical effect of forearm flap with double thickness skin graft obtained by proximal cardiac step incision for repairing donor site defect[J]. China Journal of Oral and Maxillofacial Surgery, 2026, 24(2): 155-160.

References

[1] 马治超, 孙黎波, 周航宇, 等. 折叠游离前臂皮瓣修复颊癌术后洞穿性缺损的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 1002-1005.
Ma ZC, Sun LB, Zhou HY, et al.Clinical application of folded free radial forearm flaps for reconstruction of full-tickness cheek defects after resection of buccal carcinoma[J]. Journal of clinical otorhinolaryngology head and neck surgery, 2018, 32(13): 1002-1005.
[2] Farlow JL, McCrary HC, Meeker M, et al. The osteocutaneous radial forearm free flap: a multidisciplinary review of the evidence[J]. Oral Oncol, 2024, 157: 106925.
[3] Fatani B.Radial forearm free flap for head and neck defect reconstruction: an up-to-date review of the literature[J]. Cureus, 2023, 15(3): e35653.
[4] Mosquera C, Weyh A, Malik M, et al.Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: a systematic review[J]. Microsurgery, 2024, 44(1): e31126.
[5] Zhang C, Pandya S, Alessandri Bonetti M, et al.Comparison of split thickness skin graft versus full thickness skin graft for radial forearm flap donor site closure: a systematic review and meta-analysis[J]. Am J Otolaryngol, 2024, 45(2): 104156.
[6] Bashir MA, Fung V, Kernohan MD, et al."Z-plasty" modification of ulnar-based fasciocutaneous flap for closure of the radial forearm flap donor defect[J]. Ann Plast Surg, 2010, 64(1): 22-23.
[7] Hui KC, Zhang F, Lineaweaver WC.Z-plasty closure of the donor defect of the radial forearm free flap[J]. J Reconstr Microsurg, 1999, 15(1): 19-21.
[8] Martin MC, Machado GR, Wong WW, et al.Transverse ulnar forearm flap[J]. J Craniofac Surg, 2010, 21(6): 1741-1714.
[9] Hsieh CH, Kuo YR, Yao S F, et al.Primary closure of radial forearm flap donor defects with a bilobed flap based on the fasciocutaneous perforator of the ulnar artery[J]. Plast Reconstr Surg, 2004, 113(5): 1355-1360.
[10] 王少新, 李灵, 刘吉峰, 等. 改良前臂皮瓣的制备及其供区修复方法[J]. 中华整形外科杂志, 2017, 33(1): 63-64.
Wang SX, Li L, Liu JF, et al.Preparation of improved forearm flap and its donor site repair[J]. Chinese Journal of Plastic Surgery, 2017, 33(1): 63-64.
[11] Lane JC, Swan MC, Cassell OC.Closure of the radial forearm donor site using a local hatchet flap: analysis of 45 consecutive cases[J]. Ann Plast Surg, 2013, 70(3): 308-312.
[12] 高政阳, 蒋灿华, 陈洁, 等. 桡侧蒂旋转推进筋膜皮瓣修复前臂皮瓣供区缺损[J]. 华西口腔医学杂志, 2016, 34(5): 478-482.
Gao ZY, Jiang CH, Chen J, et al.Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect[J]. West China Journal of Stomatology, 2016, 34(5): 478-482.
[13] 陈传俊, 王祎, 王来平, 等. 前臂Kiss皮瓣设计及其应用价值探讨[J]. 中国口腔颌面外科杂志, 2019, 17(4): 349-351.
Chen CJ, Wang W, Wang LP, et al.Kiss flap design of radial forearm flap for primary closure of donor-site without skin-grafting[J]. China Journal of Oral and Maxillofacial Surgery, 2019, 17(4): 349-351.
[14] 俞梦华. 改良桡侧前臂游离皮瓣(MRFFF)在口腔颌面部恶性肿瘤切除缺损即刻修复中的应用[D]. 杭州: 浙江大学, 2017.
Yu MH.Modified radial forearm free flap and its application in the immediate reconstruction of the oral and maxillofacial defects after malignant tumor ablation[D]. Hangzhou: Zhejiang University, 2017.
[15] 李晓高, 邓华, 何倩婷. 前臂梭形皮瓣在口腔颌面部中、小型缺损修复中的应用[J]. 中国口腔颌面外科杂志, 2024, 22(5): 473-477.
Li XG, Deng H, He QT, et al.Application of forearm fusiform flap in repairing medium and small defects in oral and maxillofacial region[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(5): 473-477.
[16] 明华伟, 袁宗毅, 张兴安, 等. 带感觉神经游离股前外侧皮瓣在口腔癌术后缺损修复重建中的临床应用[J]. 中国美容医学, 2025, 34(2): 58-61.
Ming HW, Yuan ZY, Zhang XA, et al.Clinical application of free anterolateral thigh flap with sensory nerve in postoperative reconstruction of oral cancer[J]. Chinese Journal of Aesthetic Medicine, 2025, 34(2): 58-61.
[17] 张志, 魏在荣, 刘琰, 等. 自体皮片游离移植技术临床操作专家共识[J]. 中国美容整形外科杂志, 2024, 35(11): 629-640.
Zhang Z, Wei ZR, Liu Y, et al.Expert consensus on clinical operation of autologous skin grafting technique[J]. Chinese Journal of Aesthetic And Plastic Surgery, 2024, 35(11): 629-640.
[18] Papanikolas MJ, Clark JR.Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers[J]. ANZ J Surg, 2024, 94(1-2): 140-147.
[19] Wu TJ, Saggi S, Badran KW, et al.Radial forearm free flap reconstruction of glossectomy defects without tracheostomy[J]. Ann Otol Rhinol Laryngol, 2022, 131(6): 655-661.
[20] 利春叶, 王建云, 廖全全, 等. 不同张力缝合对皮瓣愈合影响的实验研究[J]. 中华显微外科杂志, 2006, 29(4): 284-286.
Li CY, Wang JY, Liao QQ, et al.Experimental study on the effect of different tension suture on flap healing[J]. Chinese Journal of Microsurgery, 2006, 29(4): 284-286.
[21] Lu YY, Fang CC, Hong CH, et al.Nonmuscle myosin Ⅱ activation regulates cell proliferation, cell contraction, and myofibroblast differentiation in keloid-derived fibroblasts[J]. Adv Wound Care (New Rochelle), 2020, 9(9): 491-501.
[22] 叶文凯, 孟曦男, 徐素宏. 瘢痕形成中胶原分泌机制的研究进展[J]. 浙江大学学报(医学版), 2025, 54(2): 266-278.
Ye WK, Meng XL, Xu SH.Research progress on collagen secretion mechanisms in scarring[J]. Journal of Zhejiang University(Medical Sciences), 2025, 54(2): 266-278.
[23] 王浩然, 王映, 葛良玉, 等. 张力对改良前臂皮瓣供区恢复的影响[J]. 口腔疾病防治, 2022, 30(5): 345-349.
Wang HR, Wang Y, Ge LY, et al.Effect of tension on recovery of the donor site of a modified forearm flap[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2022, 30(5): 345-349.