Evidence map›Paper›PMID 40426263›Full record

SynthesisSystematic reviews2025

Full-thickness skin graft versus split-thickness skin graft for fasciocutaneous radial forearm free flap donor site closure: a systematic review and meta-analysis.

Jasper J E Moors, Zhibin Xu, Kunpeng Xie, Ashkan Rashad, Oliver Vladu, Jan Egger, Rainer Röhrig, Frank Hölzle, Behrus Puladi

Abstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Systematic reviews, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jasper J E MoorsDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany.ORCID 0009-0004-2067-3728
Zhibin XuDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany.ORCID 0000-0002-7130-5595
Kunpeng XieDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany.ORCID 0009-0005-8678-6300
Ashkan RashadDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany.ORCID 0000-0003-3743-8658
Oliver VladuDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany.ORCID 0009-0003-0735-3060
Jan EggerCancer Research Center Cologne Essen (CCCE), West German Cancer Center Essen (WTZ), 45122, Essen, Germany.ORCID 0000-0002-5225-1982
Rainer RöhrigInstitute of Medical Informatics, University Hospital RWTH Aachen, 52074, Aachen, Germany.ORCID 0000-0002-0032-5118
Frank HölzleDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany.ORCID 0000-0002-2298-3517
Behrus PuladiDepartment of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, 52074, Germany. bpuladi@ukaachen.de.ORCID 0000-0001-5909-6105

Funding

Medizinische Fakultät, RWTH Aachen University Senior Clinician Scientist Program
6 · The paper itself

Abstract

backgroundThe radial forearm free flap (RFFF) is widely used in microvascular reconstructions. However, donor site morbidity remains a concern, with complications such as wound healing issues, functional impairments, and aesthetic concerns. While both full-thickness skin grafts (FTSG) and split-thickness skin grafts (STSG) are commonly used for donor site closure, there is insufficient evidence to determine which technique leads to fewer complications. This study aims to systematically compare FTSG and STSG in RFFF donor site closure.

methodsWe searched six databases and four clinical trial registries up to 1 March 2025. We focused on studies comparing FTSG and STSG. Primary outcome was the incidence of wound complications. Secondary outcomes included functional and aesthetic impairment. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) and quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

resultsFifteen studies were analyzed, involving 933 donor site closures. No RCTs met our inclusion criteria. Meta-analysis comparing FTSG versus STSG revealed no significant differences in major wound complications (RR 0.43; 95% CI 0.11 to 1.70; p = 0.23) and minor wound healing complications (RR 0.83; 95% CI 0.60 to 1.13; p = 0.23), with the evidence graded as low to very low certainty.

conclusionCurrent evidence does not conclusively favor either FTSG or STSG for radial forearm free flap donor site closure regarding wound, functional, or aesthetic outcomes. Future well-designed RCTs are needed to provide higher-quality evidence to guide clinical decision-making. Until more robust evidence becomes available, the optimal skin graft choice should be guided by patient-specific factors, surgical considerations, and donor site characteristics. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023351903.

Indexed as

ForearmFree Tissue FlapsPlastic Surgery ProceduresSkin TransplantationTransplant Donor SiteHumansPostoperative ComplicationsWound HealingDonor site closureDonor site morbidityFull-thickness skin graftRadial forearm free flapSplit-thickness skin graft

Identifiers

PMID40426263
PMCPMC12108030

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.