Osteocutaneous radial forearm free flap: Its use without significant donorsite morbidity

While the fasciocutaneous radial forearm free flap has gained increasing po pularity the osteocutaneous radial forearm free flap has been condemned bec ause of a high rate of pathologic donor radius fracture. On the basis of st udies that demonstrated increased strength in ostectomized radii after dyna mic compression plating, we believed that internal fixation at the time of graft harvest would significantly reduce the incidence of donor radius frac ture. This is a retrospective review of the first 54 patients undergoing os teocutaneous radial forearm free flap reconstruction of the head and neck a t our institution; 52 underwent prophylactic plating of their donor radii. No clinically significant donor radius fractures have occurred in plated pa tients. Five asymptomatic fractures were discovered on routine radiographs and required no treatment. Objective evaluation of forearm range of motion and strength after graft harvest demonstrated excellent function compared w ith unoperated arms. Serial radiographs have shown remodeling and reconstit ution of donor radii without localized osteopenia.