Background: A split-thickness skin graft is usually performed to cover a large full-thickness skin defect. Aesthetic and functional deficits can result, and many studies have sought to overcome them. This study compared the effectiveness of the acellular dermal matrix (ADM) graft and split-thickness skin graft concerning aesthetic and functional effectiveness of ADM on scar quality of the donor site of anterolateral thigh free flap compared to split thickness skin graft only.
Methods: Of the patients who underwent anterolateral thigh free flap defect coverage from 2011 to 2015 at our institution, patients who received skin graft only (n=10) or skin graft with ADM (n=20) for coverage of the donor site were enrolled. The retrospective study reviewed medical records and clinical photos to investigate early outcome (skin loss rate, duration of negative-pressure wound therapy); days to removal of stitches; days to achieve complete healing; complications; days from surgery to the start of rehabilitation); late outcomes in terms of scar vascularity, pigmentation, pliability and height; and graft-related itching sensation and pain. Assessments used the Vancouver Scar Scale (VSS) and patient scar assessment scale of the Patient and Observer Scar Assessment Scale (POSAS). Skin fold was measured to evaluate the elasticity of scar tissue.
Results: There was no statistically difference in sex, age, underlying disease, defect size, and the early outcomes between two groups. The VSS vascularity subscore (p=0.003) and total score (p=0.016) were significantly lower in the skin graft with ADM group. POSAS pain (p=0.037) and stiffness subscore (p=0.002), and total score (p=0.017) were significantly lower in the skin graft with ADM group.
Conclusions: ADM applied to a full-thickness skin defect could result in a better scar quality. Delay in graft take could be compensated by negative-pressure wound therapy at the skin graft site.
