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



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.


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.


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.


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.


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


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.


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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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