Tissue Recycling with Split-Thickness Skin Graft Harvested from a Failed Free Flap

Failure of free flaps is frustrating for both patients and surgeons. Since a large amount of tissue was already used in the first operation, much consideration should be given to donor site and tissue preservation in revision procedures. Recycling tissue by salvaging skin from the failed flap is one option. A 59-year-old man with a scar contracture deformity on his right medial thigh underwent scar tissue excision and thoracodorsal artery perforator free flap coverage. Unfortunately, flap compromise was found on the second postoperative day and flap salvage failed due to extensive thrombus. A second thoracodorsal artery perforator free flap from the contralateral side was used for revision surgery. A split-thickness skin graft was performed with skin harvested from the failed flap to cover the second donor site. Multiple hand-held retractors provided appropriate tension for harvesting the skin. The grafted skin was successfully taken after 3 weeks. This study explores the viability of a split-thickness skin harvested from a failed flap with more than 48 hours of ischemic time. The reusability of skin from a failed free flap in revision surgery can both minimize the need for additional donor sites and reduce unnecessary pain.