SLR - January 2021 - Sara M. Solar

Association of Bolster Duration with Up-take Rates of Fibula Donor Site Skin Grafts

Reference: Abel P. David, Chase Heaton, Andrea Park. Association of Bolster Duration with Up-take Rates of Fibula Donor Site Skin Grafts. JAMA Otolaryngol Head Neck Surg. 2020;146(6):537-542. doi:10.1001/jamaoto.2020.0160

Level of Evidence: Level 2 : Retrospective cohort study

Scientific Literature Review

Reviewed By: Sara M. Solar DPM
Residency Program: University Hospital – Newark, NJ

Podiatric Relevance: This article questioned whether a longer bolster duration would improve split thickness skin graft uptake for a fibular free flap donor site.

Methods: This retrospective cohort study consisted of 42 adult patients in May 2013 who underwent fibula free flap reconstruction for head and neck deformities. STSGs were taken from the fibula skin paddle or from the ipsilateral thigh. The bolster consisted of cotton soaked in mineral oil, xeroform, and gauze soaked in bismuth tribromophenate and petrolatum. The bolster was removed on day five or 14. The bolster duration changed depending on lack of success rates. STSG uptake rate at four weeks was the main outcome measure. Inclusion criteria consisted of the need for a split thickness skin graft for fibula donor site closure. Exclusion criteria prior fibula trauma or surgery, previous history of organ transplant, use of immunosuppressants, or preoperative albumin levels of less than 2.0 g/dL. Graft uptake and loss was outlined by three doctors who were blinded to the study. Graft percentage uptake was measured by a software program.

Results: Of the 42 patients, 31 were male and the average age was 62.1 +/- 13.1 years. Twenty patients were in the five day bolster group and 22 patients were in the 14 day group. At one month the 14 day group had 77.5 percent uptake versus 59.9 percent in the five day group. Two patients in the five day group and one in the 14 day group had total graft loss.

Conclusions: Delayed wound healing was the most common complication in this study. Bolsters that were removed at 14 days post operatively had greater uptake than the five day bolster group at one month. These results promote the importance of longer lengths of graft immobilization for fibula free flap donor site. The strength of this study was the use of the image processing software. The limitations include its retrospective nature and not all patients in the 14 day group had the bolster removed on day 14.

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