Patient Self-Report of Disability of the Upper Extremity following Osteocutaneous Radial Forearm Free Flap Harvest

Abstract

The authors critically analyzed long-term upper extremity outcome after harvest of an osteocutaneous radial forearm free flap by correlating any restrictions in range of motion and strength with patient self-report of disability. Twelve patients who had at least 1 year since surgery were evaluated with a functional examination and with the Disability of the Arm, Shoulder, and Hand questionnaire. Functional capacity was quantified by comparing range of motion of the thumbs, digits, and wrists along with pronation and supination of bilateral forearms. Pinch and grip strength measurements were obtained. Range of motion in full active wrist extension, wrist flexion, forearm supination, and thumb interphalangeal flexion averaged 83 percent (p = 0.01), 82 percent (p = 0.01), 83 percent (p = 0.03), and 88 percent (p = 0.03), respectively, that of the nonflap arm. Three patients demonstrated thumb opposition limited to the ring finger. Increasing scores on the questionnaire (mean, 16.6; range, 0 to 69), indicating a worsening disability, were correlated with decreasing wrist flexion (p < 0.01; Spearman correlation coefficient, 0.77) and decreasing wrist extension (p = 0.09; Spearman correlation coefficient, 0.51) of the flap arm. Radiographs revealed one malunion secondary to a postoperative pathologic fracture in the patient with the worst questionnaire score. Three patients (25 percent) stated explicitly that harvest of the osteocutaneous radial forearm free flap had created a disability. Objective reductions in wrist, forearm, and/or thumb range of motion are frequent after harvest of an osteocutaneous radial forearm free flap. Wrist range of motion has the greatest impact on patient self-report of disability and may in a minority of patients be perceived as causing a clinically significant disability.