Tissue expansion using osmotically active hydrogel systems for direct closure of the donor defect of the radial forearm flap

Although widely used, the radial forearm flap has been criticized for the p oor quality of its donor site. Attempts to avoid donor-site problems have c oncentrated on the elaboration of the split-thickness and full-thickness sk in graft methods of reconstruction. Skin grafts frequently fail over the fl exor carpi radialis tendon, leading to chronic skin breakdown or, at best, tendon adhesion. Tissue expansion appears to be a good alternative that all ows the use of local tissues to ultimately improve the forearm donor-site a ppearance. To avoid the disadvantages of traditional silicone balloon expan ders (such as pressure peaks, infection, the valve at a distance from the e xpander, postoperative fillings), an osmotically active system was used. In an 18-month prospective study, 10 osmotically active hydrogel tissue expan ders were placed on the forearms of 10 patients. The radial forearm flap wa s performed for intraoral reconstruction after surgical resection of oral c avity malignancies. The study showed that, in nine out of 10 patients, the expanded skin achieved was sufficient to cover the donor site after raising the forearm flap. Additionally, the expansion-related swelling pressure wa s well tolerated by the patients, the cosmetic results were very satisfacto ry, and the incidence of complications was very low. Bp using osmotically a ctive hydrogel tissue expanders, there is no postoperative filling and no r isk of complications arising from defective balloon expanders, filling valv es, or missing ports.