Wrist immobilisation of radial artery forearm flap (RAFF) donor site following split-thickness skin graft: A scoping review.

Abstract

Introduction: The radial artery forearm flap (RAFF) is a versatile free tissue transfer used for many clinical presentations. RAFF donor sites typically require a split-thickness skin graft (STSG) for closure. Whilst early rehabilitation of RAFF donor site(s) following STSG commonly involves wrist immobilisation, best practice for this immobilisation procedure remains unknown.

Purpose of the study: The purpose of this study was to systematically 'map' wrist immobilisation methods post-STSG of the RAFF wound and explore the impact of immobilisation methods on donor site morbidity.

Methods: A scoping review was completed. Literature searching was conducted from database inception to February 1, 2024 in PubMed, Medline, Cochrane, CINAHL, Embase, Web of Science. Title/abstract screening was conducted by one researcher, full text screening was conducted by two researchers independently. Data extraction included number of participants, participant age and gender, wrist immobilisation details and reported donor site complications. Critical appraisal of articles was not completed.

Results: Thirty-seven studies were included in the review. Thermoplastic orthoses (TPO) or 'splinting' (n = 22) and plaster casts (n = 8) were the most frequent immobilisation methods reported with 7 days (n = 15) the most frequent immobilisation period. Detail regarding type of TPO material and location/design of the splint/cast was limited. Frequent donor site morbidities included graft complications (n = 18), changes in sensation (n = 9) and infection (n = 7).

Conclusion: Best practice wrist immobilisation procedure for RAFF donor site following STSG cannot be concluded at this time. Additional prospective research is recommended to evaluate the association between wrist immobilisation and donor site morbidity for this complex procedure.