Hyaluronic-Carboxymethylcellulose Membrane as a Biologic Barrier in Flap Delay

Bioresorbable hyaluronate-carboxymethylcellulose membranes (HA membrane) have been applied to prevent adhesion formation following gynecologic and abdominal procedures. However, the use of HA membrane to enhance flap delay has not been well described. We present a novel application of HA membranes as barriers in delayed flaps for reconstructive surgery.

All cases where HA membrane was utilized as a barrier to separate the undersurface of the flap from its respective wound bed during a delay procedure by the senior surgeon were reviewed. Indications for use of the HA membrane included patient risk factors, flap selection, or wound size.

The HA membrane was used in 4 patients undergoing flap reconstruction with a delay procedure. Flaps included were the reverse sural fasciocutaneous flap, trapezius myocutaneous flap, and 2 paramedian forehead flaps. All of the donor wound beds showed no residual HA membrane and no tissue adherence, thus allowing minimal repeat dissection. All flaps were viable without signs of infection. All of the flaps in this study healed without any complications. There were no instances of infection, venous congestion, or delayed wound healing.

HA membranes can safely serve as degradable barriers in flaps undergoing the delay phenomenon. We speculate that HA membrane reduces reestablishment of microvascular network between the flap and its wound bed and may contribute to augmentation of the remaining circulation within the delayed flap.