Surgical outcomes of split-thickness skin grafts versus free flaps of the lateral thoracic region for incurable chronic venous ulcers

Purpose: This study conducted a comparative analysis of the effectiveness of split-thickness skin grafts (STSGs) and free flaps of the lateral thoracic region performed for coverage after extensive debridement in patients with difficult-to-treat chronic venous ulcers (CVUs) with severe symptoms.Methods: This retrospective, single-center study included 20 patients (28 cases) with CVUs. Patients who received an STSG or free-flap procedure were included in the study. Data comparing these two groups were analyzed.Results: The STSG and free-flap groups showed no significant differences in patient demographics. There was no significant difference in wound size before and after debridement between the two groups (before, 52.25±58.03 cm2 vs. 37.69±32.83 cm2, p=0.407; after, 210.92±202.80 cm2 vs. 142.63±84.01 cm2, p=0.291). Wound disruption was not significantly different between the groups (p=0.231). However, a significant difference was found in recurrence between the STSG group (n=7, 58.3%) and the free-flap group (n=1, 6.3%) (p=0.004).Conclusion: Free-flap surgery may be a good option for difficult-to-treat, recurrent CVU. Because venous ulcers require extensive debridement, a lateral thoracic region free flap, which enables the harvest of large and various forms of flaps, could be the best choice for microsurgery.