As the ALT experience moves westward, challenges are encountered in donor-site closure related to differences in patient profiles. Asian patients have thin, supple thighs compared to a more obese Western population, in which primary closure may not be possible if flap width exceeds 7 cm. Closure of the donor site with a split-thickness skin graft (STSG) results in a contour deformity and impaired function from adhesions formed between the STSG and underlying musculature. In addition, there are concerns regarding primary fascial closure due to the potential of creating thigh compartment syndrome. Objectives in this study were to determine if closure of the fascia lata could be performed safely and facilitate primary closure of the ALT donor site in Western patients.
Prospective data were collected between July 2003 and May 2005 on patients who underwent ALT harvest with primary fascia closure at a Level 1 trauma center. Variables including age, gender, body mass index (BMI), and size of flap (length × width) were collected. Compartment pressures were measured using a Stryker hand-held digital transducer at 3 intervals (preoperative, postoperative, and at 48 hr).
Twenty-three patients were evaluated over the study period. The majority of the patients (88%) were males with a mean age of 35 years. The mean BMI was 28.1 and the mean width of the flap that achieved primary closure was 8.2 cm (ranging from 7 to 12 cm). Mean compartment pressures (mmHg) increased significantly from 6.2 ± 3 mmHg preoperatively to 21.1 ± 8 mmHg (p < 0.001) postoperatively and 16.3 ± 6 mmHg at 48 hr. However, there were no negative clinical sequelae or donor-site complications in all 24 ALT flaps following primary closure with fascial imbrication.
Although fascia compartment pressures increased significantly in patients who underwent primary ALT donor-site primary fascia closure, there were no negative sequelae. Thus, fascia lata imbrication can be performed safely and can facilitate primary closure in the more obese Western trauma population.
