Harvesting Thin Skin Grafts from Pedicled Flaps versus Traditional Skin Grafting in Lower Limb Reconstruction: A Prospective Comparative Study

Eskandarlou, Mahdi; Seif Rabie, Mohammad Ali

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Harvesting Thin Skin Grafts from Pedicled Flaps versus Traditional Skin Grafting in Lower Limb Reconstruction: A Prospective Comparative Study

Mahdi Eskandarlou ^*¹

, Mohammad Ali Seif Rabie²

1- Department of General Surgery, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran , dr.eskandarlou@gmail.com
2- Department of Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract: (15 Views)

Background: Chronic and complex lower limb wounds often require pedicled flaps with thin skin grafts from distant donor sites, leading to donor site morbidity such as pain and scarring. Harvesting grafts from the flap surface may reduce complications and improve functional outcomes. We evaluated the efficacy of flap-surface grafting compared to traditional distant-site grafting.
Methods: This prospective study enrolled 40 patients (38 men, 2 women; mean age 42 years) with traumatic or orthopedic lower limb defects (mean size 12 cm²). Twenty patients received traditional skin grafts from distant sites (control group), while 20 received grafts harvested from fasciocutaneous or musculocutaneous pedicled flaps (intervention group). Outcomes included flap survival, pain (Visual Analog Scale, VAS), patient satisfaction (Likert scale), and limb mobility, assessed on postoperative days 1–5, 14, 35, and 90. Statistical analysis used the Mann-Whitney U test.
Results: Flap survival was achieved in 19/20 intervention group patients (no necrosis) and 20/20 control group patients. The intervention group reported significantly lower pain scores (mean VAS: 2.1 vs. 4.3, P< 0.001), higher satisfaction (mean Likert: 4.5 vs. 3.2, P < 0.001), and improved mobility scores (P< 0.001) at 90 days.
Conclusion: Harvesting thin skin grafts from pedicled flaps preserves flap integrity, eliminates donor site morbidity, and enhances patient satisfaction and functional outcomes. This technique offers a promising advancement for lower limb reconstruction, warranting further investigation.

Keywords: Chronic wounds, Donor site morbidity, Fasciocutaneous flaps, Limb mobility, Lower extremity, Musculocutaneous flaps

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Type of Study: Original Article | Subject: Special