European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1219–1225 | Cite as

Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques

  • Markus Pirlich
  • Iris-Susanne Horn
  • Christian Mozet
  • Mandy Pirlich
  • Andreas Dietz
  • Miloš Fischer
Head and Neck
  • 57 Downloads

Abstract

Background

The use of the radial forearm-free flap is a well-established and reliable reconstruction method in head and neck surgery. Usually, the defect of the donor site is covered with full or split-thickness skin grafts. Since 09/2013, a direct closure of the radial forearm donor site has been performed at the ENT University Hospital Leipzig to avoid secondary donor site morbidity. However, few data are available in the literature on long-term cosmetic and functional results compared to the established indirect donor site defect coverage.

Methods

This study investigated patients with radial forearm-free flap harvest from 01/2012 until 03/2015. A total of n = 39 patients were included, with n = 18 being operated by indirect (group 1) and n = 21 by direct closure technique (group 2). For the validation of surgical revisions and wound healing disorders, we carried out clinical investigations as well as interviews. The “POSAS Observer and Patient Scale” was used for assessing the cosmetic outcome and the “Michigan Hand Outcome Questionnaire (MHQ)” for functional criteria.

Results

Group 2 showed an increased rate of wound healing problems, however it was not statistically different compared to group 1. Revision surgery was necessary in both groups only each in one case. Using the POSAS, there were no significant differences between both groups in the observer scale for the items vascularity, pigmentation, thickness, relief, pliability, surface area and even for pain, scar itching, color, stiffness, thickness and relief in the patient scale. The functional results (MHOQ) also showed no significantly inferior results for group 2.

Conclusions

The direct closure procedure is quick, simple and can be performed without secondary donor site morbidity. For wound healing, cosmetic and function of the forearm and hand, no inferior results can be measured for the direct procedure compared to the indirect coverage technique.

Keywords

Radial forearm-free flap Donor site morbidity Skin graft Free tissue transfer Head and neck reconstructive surgery 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Sturgis EM, Ang KK (2011) The epidemic of HPV-associated oropharyngeal cancer is here: is it time to change our treatment paradigms? J Natl Compr Cancer Netw 9(6):665–673CrossRefGoogle Scholar
  2. 2.
    Yang G, Chen B, Gao Y (1981) Free transfer of forearm flap. Report of 56 cases. 1981. Br J Plast Surg 50(3):162–165CrossRefGoogle Scholar
  3. 3.
    Ho T, Couch M, Carson K, Schimber A, Manley K, Byrne PJ (2006) Radial forearm free flap donor site outcomes comparison by closure methods. Otolaryngol Head Neck Surg 134(2):309–315CrossRefPubMedGoogle Scholar
  4. 4.
    Orlik JR, Horwich P, Bartlett C, Trites J, Hart R, Taylor SM (2014) Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors. J Otolaryngol Head Neck Surg 43:1CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Wester JL, Pittman AL, Lindau RH, Wax MK (2014) AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg 150(1):47–52CrossRefPubMedGoogle Scholar
  6. 6.
    Wirthmann A, Finke JC, Giovanoli P, Lindenblatt N (2014) Long-term follow-up of donor site morbidity after defect coverage with Integra following radial forearm flap elevation. Eur J Plast Surg 37:159–166CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Byun SH, Ahn KM, Kim SM, Lee JH (2016) Functional and cosmetic outcome after closure of radial forearm free flap donor defect with porcine collagen membrane. J Craniomaxillofac Surg 44(5):527–532CrossRefPubMedGoogle Scholar
  8. 8.
    Riecke B, Assaf AT, Heiland M, Al-Dam A, Gröbe A, Blessmann M, Wikner J (2015) Local full-thickness skin graft of the donor arm–a novel technique for the reduction of donor site morbidity in radial forearm free flap. Int J Oral Maxillofac Surg 44(8):937–941CrossRefPubMedGoogle Scholar
  9. 9.
    Moreno-Sanchez M, Gonzalez-Garcia R, Ruiz-Laza L, Manzano Solo de Zaldivar D, Moreno-Garcia C, Monje F (2016) Closure of the radial forearm free flap donor site using the combined local triangular full-thickness skin graft. J Oral Maxillofac Surg 74(1):204–211CrossRefPubMedGoogle Scholar
  10. 10.
    Sleeman D, Carton AT, Stassen LF (1994) Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall. Br J Oral Maxillofac Surg 32(1):54–55CrossRefPubMedGoogle Scholar
  11. 11.
    Van der Lei B, Spronk CA, Visscher JG (1999) Closure of radial forearm free flap donor site with local full-thickness skin graft. Br J Oral Maxillofac Surgery 37(2):119–122CrossRefGoogle Scholar
  12. 12.
    Van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116(2):514–522CrossRefPubMedGoogle Scholar
  13. 13.
    Knobloch K, Kuehn M, Papst S, Kraemer R, Vogt PM (2011) German standardized translation of the michigan hand outcomes questionnaire for patient-related outcome measurement in Dupuytren disease. Plast Reconstr Surg 128(1):39e-40eCrossRefPubMedGoogle Scholar
  14. 14.
    Ayürek M, Safak T (2002) Direct closure of radial forearm free-flap donor sites by double-opposing rhomboid transposition flaps: case report. J Reconstr Microsurg 18(1):33–36CrossRefGoogle Scholar
  15. 15.
    Karimi A, Mahy P, Reychler H (2007) Closure of radial forearm free flap donor site defect with a local meshed full-thickness skin graft: a retrospective study of an original technique. J Craniomaxillofac Surg 35(8):369–373CrossRefPubMedGoogle Scholar
  16. 16.
    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 trial. Int J Oral Maxillofac Surg 29(3):194–197CrossRefPubMedGoogle Scholar
  17. 17.
    Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PP (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965CrossRefPubMedGoogle Scholar
  18. 18.
    Bassey EJ, Harries UJ (1993) Normal values for handgrip strength in 920 men and women aged over 65 years, and longitudinal changes over 4 years in 620 survivors. Clin Sci 84(3):331–337CrossRefPubMedGoogle Scholar
  19. 19.
    Crosby CA, Wehbé MA, Mawr B (1994) Hand strength: normal values. J Hand Surg Am 19(4):665–670CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of Otolaryngology, Head and Neck Surgery and Department of Head Medicine and Oral HealthUniversity Hospital LeipzigLeipzigGermany
  2. 2.Clinic of Otolaryngology, Head and Neck SurgerySchwarzwald-Baar HospitalVillingen-SchwenningenGermany
  3. 3.Clinic of Neurology, Department of Internal Medicine, Neurology and DermatologyUniversity Hospital LeipzigLeipzigGermany

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