Massive Flap Donor Sites and Vacuum-Assisted Closure Devices

Abstract

Objective: Determine the effect of vacuum assisted closure (VAC) on massive scapular and latissimus dorsi free flap donor site morbidity, when used over a closed incision line under great tension.

Method: Patients who underwent complex head and neck reconstruction with scapular fasciocutaneous/osteocutaneous and latissimus dorsi myocutaneous free flaps between the years of 2006 and 2010 at a tertiary academic referral center were identified and a retrospective chart review was performed.

Results: Seventy patients who underwent scapular or latissimus dorsi free flap reconstruction were identified. Those with and those without VAC over the closed incision line were identified. The method of application of the VAC dressing was performed by the same team at one institution. None of these patients required skin grafting, and only 1 patient had donor site breakdown secondarily requiring wound care and VAC replacement and 1 patient had an asymptomatic seroma; all others with VAC treatment over the closed incision line were without donor site complications.

Conclusion: Vacuum-assisted closure is a safe technique in the postoperative management of massive back free flap donor sites closed under great tension, and may eliminate the need for skin grafting. In our study, data suggests this approach decreases seroma formation and secondary wound breakdown.