Radial Forearm Free Flap Donor Site Outcomes Comparison by Closure Methods

Abstract

OBJECTIVE: To compare the functional and aesthetic outcomes of radial forearm free flap (RFFF) donor sites reconstructed with full-thickness skin graft (FTSG), split thickness skin graft (STSG) alone, and STSG overlying an acellular dermal matrix (AlloDerm). STUDY DESIGN AND SETTING: A cross-sectional cohort study at a tertiary care hospital. RESULTS: Twenty-five head and neck cancer patients who underwent reconstruction with RFFF completed the evaluations (STSG = 10, FTSG = 8, STSG with AlloDerm = 7). Subjective evaluations of postoperative function by questionnaires showed no significant differences among the 3 groups ( P = 0.93). In blinded evaluations by surgeons, the STSG group obtained the highest aesthetic outcome score (3.39 of 5.0), followed by FTSG (2.89) and STSG with AlloDerm (2.80). However, the difference was not statistically significant ( P = 0.32). Objective measurements of postoperative function by certified occupational therapists were comparable among the 3 groups with the exception of a mildly decreased range of wrist flexion ( P = 0.036) and ulnar deviation ( P = 0.016) in the FTSG group. CONCLUSIONS: The 3 methods of reconstruction have comparable postoperative functional and aesthetic outcomes. SIGNIFICANCE: Each of the 3 methods of reconstruction has low morbidity and satisfactory aesthetic and functional outcomes. EBM rating: B-2b