Arch Hand Microsurg.  2022 Dec;27(4):329-335. 10.12790/ahm.22.0052.

Surgical outcomes of split-thickness skin grafts versus free flaps of the lateral thoracic region for incurable chronic venous ulcers

• Seo HJ
• Park SO
• Kim YH

• KMID: 2536221
• DOI: http://doi.org/10.12790/ahm.22.0052

Abstract

Purpose
This study conducted a comparative analysis of the effectiveness of split-thickness skin grafts (STSGs) and free flaps of the lateral thoracic region performed for coverage after extensive debridement in patients with difficult-to-treat chronic venous ulcers (CVUs) with severe symptoms.
Methods
This retrospective, single-center study included 20 patients (28 cases) with CVUs. Patients who received an STSG or free-flap procedure were included in the study. Data comparing these two groups were analyzed.
Results
The STSG and free-flap groups showed no significant differences in patient demographics. There was no significant difference in wound size before and after debridement between the two groups (before, 52.25±58.03 cm2 vs. 37.69±32.83 cm2, p=0.407; after, 210.92±202.80 cm2 vs. 142.63±84.01 cm2, p=0.291). Wound disruption was not significantly different between the groups (p=0.231). However, a significant difference was found in recurrence between the STSG group (n=7, 58.3%) and the free-flap group (n=1, 6.3%) (p=0.004).
Conclusion
Free-flap surgery may be a good option for difficult-to-treat, recurrent CVU. Because venous ulcers require extensive debridement, a lateral thoracic region free flap, which enables the harvest of large and various forms of flaps, could be the best choice for microsurgery.

Keyword

Venous ulcer; Skin graft; Free flap

Figure

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  Fig. 1. A 27-year-old male patient with a chronic venous ulcer in the left lower leg previously received split-thickness skin grafts twice but relapsed. He complained of severe pain and recurring open wounds, which caused a detrimental impact on his daily life. (A) A skin ulcer with necrotic tissue, pigmentation of the surrounding soft tissue, and lipodermatosclerosis is observed. (B) After extensive debridement of the skin ulcer and surrounding tissue, coverage was performed using a thoracodorsal artery perforator flap. The posterior tibial vessel was used as the recipient vessel. (C) A photograph taken 9 months after surgery. No recurrence was observed, and the previous symptoms had all disappeared. In addition, the degeneration of the surrounding skin was resolved, providing satisfactory aesthetic results.

Reference

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