Closure of radial forearm free flap donor site: A comparative study between keystone flap and skin graft

Background The aim was to investigate the feasibility of radial forearm free flap (RFFF) donor site closure by keystone flap (KF) and compare its outcomes to those of skin graft (SG) closure. Methods One hundred and one patients who underwent RFFF for head and neck reconstruction were included (35 KF closure and 65 SG closure). Duration of wound healing and donor site complications was collected. After a minimal follow‐up of 1 year, patients were questioned about functional and esthetic impairment. Results Coverage of donor site by KF was successful in all cases. The duration of wound healing was longer after SG than after KF (32 days vs 18 days, P < .001). Healing complications, esthetic and functional results were not statistically different. Conclusion Forearm donor site closure by KF is a feasible alternative to the traditional SG. Its main advantages are the reduced wound healing time and the avoidance of a second donor site

Flow diagram of the selection process used in this study.

<p>The search was conducted on 15 September 2014. Merging the search results gave a total of 41 clinical trials investigating the efficacy or safety of snake antivenoms, of which four were active. A total of 36 different antivenoms were investigated (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.t002" target="_blank">Table 2</a>). Based on the trial design (Phase I to IV), ten products were considered still “under development,” although development appears to have stalled for most of them. Our search strategy appears robust; a report conducted in 2010 identified a total of 43 randomized controlled trials on snakebite envenoming, 28 of which investigated antivenom properties [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.ref011" target="_blank">11</a>]. We retrieved all except two of these trials [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.ref012" target="_blank">12</a>,<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.ref051" target="_blank">51</a>]; the discrepancy could be due to differences in the criteria used to define clinical trials.</p

List of antivenoms investigated in clinical trials published in peer-reviewed journals or on public registries.

<p>¹ Not all publications mentioned the trial phase, and development status was established based on trial design, primary objectives, and number of subjects. This classification, though, bears some limitations, especially with regards to snake antivenoms development, in which Phase I with healthy volunteers are generally not conducted.</p><p>List of antivenoms investigated in clinical trials published in peer-reviewed journals or on public registries.</p

Available snake antivenom products in sub-Saharan Africa, as of September 2014.

<p>Available snake antivenom products in sub-Saharan Africa, as of September 2014.</p