Full-Thickness Skin Graft as a One-Stage Debulking Procedure after Free Flap Reconstruction for the Lower Leg

BACKGROUND: Bulky appearance is one of the major patient complaints after lower leg reconstruction with free flap transfer. This unsatisfactory outcome results from protuberance of the reconstructed section and an unequal limb diameter when compared with the normal side. Serial debulking procedures, such as staged excision, can result in some improvement, but these methods are time consuming and do not provide a one-stage procedure for flap thinning, especially for the pretibial area, ankle, and foot. The authors used a full-thickness skin graft as a one-stage debulking procedure to achieve good aesthetic and functional results. METHODS: From January of 2002 to June of 2004, 24 secondary debulking procedures were performed on 24 patients who had undergone reconstruction with free anterolateral thigh flaps. There were 12 perforator flaps and 12 myocutaneous flaps. Six flaps were on the pretibial area, eight were on the ankle, and 10 were on the foot. The full-thickness skin was taken away from the flap and regrafted onto the defatted wound. RESULTS: All of the skin grafts took well, except in three cases where there was superficial necrosis on the ankle. The circumference of the reconstructed limbs decreased to an average of 3.6 +/- 0.7 cm (mean +/- SD, n = 24), with no difference as compared with the normal side. CONCLUSIONS: This method can provide a one-stage debulking procedure for the pretibial area, ankle, and foot after free flap reconstruction, and achieves good aesthetic and functional outcomes.