Assessment of Donor Site Morbidity for Osteocutaneous Radial Forearm Free Flaps

Abstract

Objective: 1) Assess donor site morbidity following harvest of osteocutaneous radial forearm free flaps (OCRFF). 2), Evaluate patient perceived upper limb disability for osteocutaneous vs fasciocutaneous radial forearm free flaps Method: Retrospective cross-institutional review of OCRFF performed between 2001 and 2010. There were 218 included patients. The primary outcome measure was forearm donor site morbidity. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to compare patient perceived arm disability for osteocutaneous vs fasciocutaneous radial forearm flaps. Results: Mean patient age was 63 years with a male predominance (63%). The left arm was the donor site in 86%. Median bone length harvested was 8 cm (range, 3-12 cm). Following harvest, the radius was plated in 99% of patients. Recipient sites primarily included the mandible (62%) and maxilla (34%). Donor site morbidity included fracture (2 patients, 0.9%) and sensory neuropathy (5 patients, 2%). Fractures were treated with open reduction and internal fixation without functional deficits. Hardware extrusion was the most common complication at the recipient site (29 patients, 13%). Conclusion: Reluctance to perform OCRFF by surgeons usually centers on potential donor site morbidity. However, we identified minimal objective or patient perceived donor site morbidity following harvest of OCRFFs.