Double Layer Graft Using Temporal Fascia Graft in Tendon Exposure Wound

Soft-tissue injuries with tendon exposure in the upper extremity can be reconstructed using various options, such as free flap and regional flap techniques. While skin grafting is an alternative, its use is limited by complications such as adhesions or graft failure. Hence, the double-layer graft, often using acellular dermal matrix (ADM), is preferred. However, ADM's drawbacks, including high cost and low engraftment rate, led to the temporal fascia being considered as an alternative.

In this study, instead of the acellular dermal matrix, the temporal fascia was chosen as an intermediate-layer donor for 32 cases. A total of 20 patients underwent split-thickness skin grafting (STSG), while 12 patients underwent full-thickness skin grafting (FTSG) in the study. All patients had injuries to their upper extremities, with exposed tendons.

Of the 32 patients who received double-layer grafts through the temporal fascia, 29 patients experienced no complications during an average duration of 5.7 months of follow-up period, while 3 patients developed minor complications. Among the 3 patients, 2 experienced partial graft failure, which was successfully treated with dressing therapy postoperatively. One individual exhibited adhesion, but it did not lead to restriction of motion.

Free graft of temporalis fascia between the tendon of the upper extremity and the skin graft can act as an intermediate gliding plane, while its harvesting is manageable and cost-effective compared with an allograft. It also reinforces soft-tissue thickness, especially on the volar side of the hand, which plays an important role in hand function.