Donor Site Outcomes with Osteocutaneous versus Fasciocutaneous Radial Forearm Free Flap Harvest: Level 3 Evidence

Abstract

There is no financial information to disclose. The osteocutaneous radial forearm free flap (ORFFF) has become an increasingly utilized reconstructive tool, particularly when the morbidity of other donor sites - such as the iliac crest or fibula - are less desirable. While initially associated with high donor site morbidity - especially radius fractures - increased experience and prophylactic plating have decreased these risks. This study hypothesized that the rates of donor site complications in patients undergoing ORFFF harvest with prophylactic plating with a diaphyseal-metaphyseal plate would be similar to those seen with fasciocutaneous radial forearm free flap harvest (FRFFF harvest). A retrospective review was performed for all patients who underwent osteocutaneous or fasciocutaneous radial forearm free flap harvest with a single otolaryngology surgeon over a 3-year period. Patients requiring an osteocutaneous flap underwent harvest of half of the diaphyseal diameter of the radius with prophylactic plating performed by an orthopaedic upper extremity surgeon. A 3.5/2.4mm diaphyseal-metaphyseal, volar distal radius, locking compression plate was used (Synthes. Paoli, PA, USA). Donor site outcomes including infection, skin graft loss, tendon exposure, neuropathy, fracture, hardware complications and donor site re-operation were compared between the groups. Two-tailed, Fischer’s exact test was used for data analysis. Twenty-five patients underwent ORFFF harvest and 53 patients underwent FRFFF harvest. An average of 7.5cm of radius was harvested in the ORFFF group with only 1 radius fracture, occurring in association with a hardware infection which required hardware removal and re-plating of the radius. No fractures were reported in the FRFFF group. No other major donor site complications requiring re-operation were seen in either group. Similar rates of minor complications were seen with skin graft take less than 50% in 4% (n = 1) and 7% (n = 4) with ORFFF and FRFFF, respectively, and tendon exposure in 8% (n = 2) and 15% (n = 8) with ORFFF and FRFFF, respectively. No soft tissue infections or superficial radial sensory neuropathies were seen. Mean follow-up was 14.2 months for the ORFFF group and 11.7 months for the FRFFF group. •The risk of fracture following osteocutaneous radial forearm free flap (ORFFF) harvest with this prophylactic plating technique is small, making it a safe donor site when an osteocutenous flap is needed for reconstruction.•Donor site complications including skin graft loss, tendon exposure, soft tissue infection and superficial radial sensory neuropathy occurred at similar rates among patients undergoing osteocutaneous and fasciocutaneous flap harvest.