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Published in:

01-07-2008 | Original Paper

Radial forearm flap surgery—evaluation of donor site morbidity

Authors: A. Thiele, C. Wulke, E. Roepke, S. Knipping

Published in: European Journal of Plastic Surgery | Issue 3/2008

Abstract

The free radial forearm flap is an excellent method for reconstruction of defects in the head and neck region. In the literature, there is still disagreement about the best surgical treatment of the forearm defect to avoid functional and cosmetic drawbacks. There is a debate about using full-thickness skin graft or better split thickness skin graft. To evaluate our own results after radial forearm flap surgery, a follow-up examination and standardized interview of 25 patients was performed. For closure of the donor site, a full skin graft from the groin was used in 17 cases and split skin graft from the thigh in eight cases.

All patients were satisfied with postoperative results and hand function for everyday use. Subjective complaints were more common in the split skin graft group, especially related to loss of sensibility. Because of severe wound healing failure with tendon exposure in one case after split skin grafting, there was the necessity for surgical revision. During the medical examination, we documented more functional impairments in the split skin graft group than in patients after full skin grafting. Only the development of hypertrophic scars dominated in the full skin graft group.

According to the trend to fewer complications, we prefer full-thickness skin grafts for the closure of the donor site after radial forearm flap surgery.

Andrews BT, Smith RB, Chang KE, Scharpf J, Goldstein DP, Funk GF (2006) Management of the radial free flap donor site with the vacuum-assisted closure (VAC) system. Laryngoscope 116:1918–1922PubMedCrossRef

Avery C, Pereira J, Moody A, Gargiulo M, Whitworth I (2000) Negative pressure wound dressing of the radial forearm donor site. Int J Oral Maxillofac Surg 29:198–200PubMedCrossRef

Avery CME, Pereira J, Brown AE (2001) Suprafascial dissection of the radial forearm flap and donor site morbidity. Int J Oral Maxillofac Surg 30:37–41PubMedCrossRef

Blackwell KE, Buchbinder D, Biller HF, Urken ML (1997) Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck 19(7):620–628PubMedCrossRef

Brown MT, Couch ME, Huchton DM (1999) Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest. Arch Otolaryngol Head Neck Surg 125(12):1371–1374PubMed

Chen CM, Lin GT, Fu YC, Shieh TY, Huang IY, Shen YS, Chen CH (2005) Complications of free radial forearm flap transfers for head and neck reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:671–676PubMedCrossRef

de Bree R, Hartley C, Smeele LE, Kuik DJ, Quak JJ, Leemans R (2004) Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap. Laryngoscope 114:1973–1976PubMedCrossRef

de Witt CA, de Bree R, Verdonck-de Leeuw IM, Quak JJ, Leemans CR (2007) Donor site morbidity of the fasciocutaneous radial forearm flap: what does the patient really bother? Eur Arch Otorhinolaryngol 264:929–934PubMedCrossRef

Eckardt A, Fokas K (2003) Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. J Craniomaxillofac Surg 31(4):197–201PubMed

10.

Eckardt A, Meyer A, Laas U, Hausamen J-E (2007) Reconstruction of defects in the head and neck with free flaps: 20 years experience. Br J Oral Maxillofac Surg 45:11–15PubMedCrossRef

11.

Emerick KS, Deschler DG (2007) Incidence of donor site skin graft loss requiring surgical intervention with the radial forearm free flap. Head Neck 29:573–576PubMedCrossRef

12.

Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125(1):10–17PubMedCrossRef

13.

Huang CH, Chen HC, Huang YL, Mardini S, Feng GM (2004) Comparison of the radial forearm flap and the thinned anterolateral thigh cutaneous flap for reconstruction of tongue defects: an evaluation of donor-site morbidity. Plast Reconstr Surg 114:1704–1710PubMedCrossRef

14.

Ito O, Igawa HH, Suzuki S, Muneuchi G, Kawazoe T, Saso Y, Onodera M, Park S, Hata Y (2005) Evaluation of the donor site in patients who underwent reconstruction with free radial forearm flap. J Reconstr Microsurg 21(2):113–117PubMedCrossRef

15.

Karimi A, Mahy P, Reychler H (2007) Closure of radial forearm free flap donor site defect with local meshed full-thickness skin graft: a retrospective study of an original technique. J Craniomaxillofac Surg 35(8):369–373PubMed

16.

Kerawala CJ, Martin IC (2006) Sensory deficit in the donor hand after harvest of radial forearm free flaps. Br J Oral Maxillofac Surg 44:100–102PubMedCrossRef

17.

Kim TB, Moe KS, Eisele DW, Orloff LA, Wang SJ (2007) Full-thickness skin graft from the groin for coverage of the radial forearm free flap donor site. Am J Otolaryngol 28(5):325–329PubMedCrossRef

18.

Lee JW, Jang YC, Oh SJ (2005) Use of the artificial dermis for free radial forearm flap donor site. Ann Plast Surg 55:500–502PubMedCrossRef

19.

Lutz BS, Wei FC (2005) Microsurgical workhorse flaps in head and neck reconstruction. Clin Plast Surg 32(3):421–430PubMedCrossRef

20.

Lutz BS, Wei F-C, Chang SCN, Yang K-H, Chen I-H (1999) Donor site morbidity after suprafascial elevation of the radial forearm flap: a prospective study in 95 consecutive cases. Plast Reconstr Surg 103(1):132–137PubMedCrossRef

21.

Motomura H, Ohba N, Ohashi N, Harada T, Muraoka M, Iguchi H, Kusuki M, Yamane H (2006) Improvement of the radial forearm donor site by compression with hydrocolloid dressing and adhesive sponge. Acta Otolaryngol 126:204–208PubMedCrossRef

22.

Nuckols DA, Tsue TT, Toby EB, Girod DA (2000) Preoperative evaluation of the radial forearm free flap patient with the objective Allen's test. Otolaryngol Head Neck Surg 123(5):553–557PubMedCrossRef

23.

Pohlenz P, Blessmann M, Heiland M, Blake F, Schmelzle R, Li L (2007) Postoperative complications in 202 cases of microvascular head and neck reconstruction. J Craniomaxillofac Surg 35(6–7):311–315PubMed

24.

Rhemrev R, Rakhorst HA, Zuidam JM, Mureau MA, Hovius SE, Hofer SO (2007) Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections. J Plast Reconstr Aesthet Surg 60(6):588–592PubMedCrossRef

25.

Rowe NM, Morris L, Delacure MD (2006) Acellular dermal composite allografts for reconstruction of the radial forearm donor site. Ann Plast Surg 57(3):305–311PubMedCrossRef

26.

Shiba K, Iida Y, Numata T (2003) Ipsilateral full-thickness forearm skin graft for covering the radial forearm flap donor site. Laryngoscope 113:1043–1046PubMedCrossRef

27.

Sidebottom AJ, Stevens L, Moore M, Magennis P, Devine JC, Brown JS, Vaughan ED (2000) Repair of the radial free flap donor site with full or partial thickness skin grafts. A prospective randomised controlled trail. Int J Oral Maxillofac Surg 29:194–197PubMedCrossRef

28.

Sinha UK, Shih C, Chang K, Rice DH (2002) Use of AlloDerm for coverage of radial forearm free flap donor site. Laryngoscope 112:230–234PubMedCrossRef

29.

Smith GI, O, Brien CJ, Choy ET, Andruchow JL, Gao K (2005) Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of the oral cavity. Br J Oral Maxillofac Surg 43:199–204PubMedCrossRef

30.

Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, Blackwell KE (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 130:962–966PubMedCrossRef

31.

Toschka H, Feifel H, Erli H-J, Minkenberg R, Paar O, Riediger D (2001) Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function. Int J Oral Maxillofac Surg 30:42–48PubMedCrossRef

32.

van der Lei B, Spronk CA, de Visscher JGAM (1999) Closure of radial forearm free flap donor site with local full-thickness skin graft. Br J Oral Maxillofac Surg 37:119–122PubMedCrossRef

33.

Wax MK, Winslow CP, Andersen PE (2002) Use of allogenic dermis for radial forearm free flap donor site coverage. J Otolaryngol 31(6):341–345PubMedCrossRef

34.

Zuidam JM, Coert JH, Hofer OP (2005) Closure of the donor site of the free radial forearm flap. A comparison of full-thickness graft and split-thickness skin graft. Ann Plast Surg 55:612–616PubMedCrossRef

Title: Radial forearm flap surgery—evaluation of donor site morbidity
Authors: A. Thiele
C. Wulke
E. Roepke
S. Knipping
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: European Journal of Plastic Surgery / Issue 3/2008
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-008-0238-y

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