Donor site morbidity after suprafascial elevation of the radial forearm flap: A prospective study in 95 consecutive cases

From March of 1995 to November of 1997, 95 free radial forearm flaps for or ofacial reconstructions were performed and included in this prospective stu dy of donor site morbidity. All flaps were elevated using the suprafascial dissection technique. Donor site closure was performed with either split-th ickness skin grafts (64 cases) or full-thickness skin grafts (31 cases). Among the 95 flaps, there were two complete flap losses and one partial fla p loss because of arterial thrombosis. One orocutaneus fistula was successf ully treated with a pedicled pectoralis major flap. At the donor site, the rate of complete take of skill graft was 94 percent in 95 patients. Functional and aesthetic results evaluated at least 6 month s postoperatively in 50 patients revealed no significant change in grip pow er, pulp-to-pulp pinch power, or wrist movement in the complete skin graft take group (45 cases), whereas in the partial skin graft failure group (5 c ases), both grip power and movement were significantly decreased. There was no remarkable cold intolerance in any of the 50 patients. Critical evaluat ions of sensory change revealed numbness distal to the donor site in 54 per cent of the patients. However, dysesthesia was usually mild and improved sp ontaneously as time passed. Aesthetic outcome was rated as good or fail in 98 percent of the cases. The results of this prospective study show that suprafascial elevation of t he radial forearm flap is superior to the classic elevation technique, part icularly with regard to a higher rate of immediate complete take of skin gr afts, thus avoiding impairment of range of motion and strength of the donor hand.