[Sportschosun, Jang Jong-ho] A study has found that when repairing skin defects in the forearm after head and neck reconstructive surgery, grafting skin from the inner arm produced better cosmetic results than the conventional method of using thigh skin.
The study stands out from previous research because it quantified cosmetic outcomes after skin grafting using objective measures rather than subjective evaluations by patients or medical staff.
Radial forearm free flap (RFFF) surgery is widely used to reconstruct tissue defects that remain after removing head and neck cancers of the tongue, face, or neck. In this procedure, skin and soft tissue are taken from the forearm between the elbow and wrist, along with blood vessels, and transplanted. However, this leaves a relatively large skin defect on the donor forearm, which must be covered with a skin graft from another area.
In general, a split-thickness skin graft, which takes a thin layer of skin from the thigh, is commonly used. It can cover a relatively large area, but after surgery the color may differ from the surrounding skin, and the surface can become uneven as the skin contracts.
By contrast, a full-thickness skin graft removes the entire skin layer from the inner upper arm of the same arm and uses it for transplantation. The inner upper arm is close to the forearm, the recipient site, so the skin characteristics are similar. The donor site can also be closed directly, leaving a less noticeable linear scar instead of a broad graft mark.
Against this backdrop, a research team led by Professor Yoo Hee-jin of the Department of Plastic Surgery at Korea University Ansan Hospital and Professor Lee Gyu-il of the Department of Plastic Surgery at Korea University Guro Hospital compared postoperative skin color and texture in 39 patients who underwent RFFF reconstruction for head and neck defects from 2018 to 2024. Of them, 21 received full-thickness skin grafts from the inner upper arm, while 18 received split-thickness skin grafts from the thigh.
The analysis found that the dE2000 score, which measures color difference from surrounding normal skin, averaged 4.9 in the full-thickness graft group, significantly lower than 8.8 in the split-thickness graft group. The lower the score, the more similar the skin color is to the surrounding area. The color match was rated as "very good" in the full-thickness graft group and "moderate" in the split-thickness graft group.
Differences were also seen in skin texture. The full-thickness graft group had a homogeneity score of 0.46, indicating greater surface uniformity, compared with 0.36 in the split-thickness graft group. Its entropy score, which reflects irregularity, was 6.0, lower than 6.5 in the split-thickness graft group. However, there was no significant difference in complication rates, including partial necrosis, hypertrophic scarring, and sensory abnormalities.
Professor Yoo Hee-jin of the Department of Plastic Surgery at Korea University Ansan Hospital said, "In head and neck cancer surgery, we must consider not only successful reconstruction of the removed cancer site, but also recovery of the donor site and the cosmetic outcome." She added, "Through this study, we objectively confirmed that a full-thickness skin graft from the inner upper arm can reduce the color difference between the forearm graft site and the surrounding skin, while helping create a more uniform skin texture."
She also emphasized, "However, because the feasibility of a full-thickness skin graft can vary depending on the patient's condition, including the size of the skin needed and the amount of available skin on the inner upper arm, it is important to make a comprehensive assessment and choose the appropriate grafting method."
The findings were recently published in the international journal Annals of Plastic Surgery.
Jang Jong-ho, bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
