Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques

Pirlich, Markus; Horn, Iris-Susanne; Mozet, Christian; Pirlich, M; Dietz, Andreas; Fischer, M

doi:10.1007/s00405-018-4908-5

Cited by 22 publications

(16 citation statements)

References 21 publications

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“…Wirthmann et al 12 reported that the satisfaction score for the esthetic appearance of the donor site after RFF flap surgery was 3.42 on average, which was acceptable, and the Vancouver Scar Scale resulted in a value of 4.2, representing a good result. Others have introduced different techniques of coverage of the donor site to improve the cosmetic results, including porcine collagen membrane, 13 acellular matrix, 14 autologous fat transplantation, 15 and local or distant full‐thickness skin graft 16 . All studies have reported satisfactory results, indicating that donor site appearance might not be of concern if appropriate modified methods were used.…”

Section: Discussionmentioning

confidence: 99%

Long‐term donor site morbidity after radial forearm flap elevation for tongue reconstruction: Prospective observational study

et al. 2020

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Background: To assess long-term donor site morbidity after radial forearm free (RFF) flap harvesting. Methods: Enrolled patients were asked to complete the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and undergo wrist motion and hand strength examinations at different time points. The data were prospectively collected and retrospectively analyzed. Results: The postoperative DASH score did not return to normal until 24 months after the operation. The mean postoperative wrist motion degree of flexion was significantly decreased compared to the preoperative level and returned to normal at 12 months after the operation. Similar trends were noted regarding extension, radial abduction, and ulnar abduction. The mean postoperative grip strength was significantly decreased compared to the preoperative level and remained dysfunctional at 24 months after the operation. A similar trend was also noted with regard to tip pinch and key pinch. Conclusion: The long-term negative effect on hand strength is sustained.

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Section: Discussionmentioning

confidence: 99%

Long‐term donor site morbidity after radial forearm flap elevation for tongue reconstruction: Prospective observational study

et al. 2020

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“…A study by Pirlich et al compared functional outcomes between donor-site closure with an FTG or direct closure; however, no substantial difference in pain incidences was found between the two techniques. 28 Four studies used flaps for donor-site closure, including an anterolateral thigh flap 29 , an ulnar-based transposition flap 13 , a bilobed flap 30 , and a keystone flap 19 , however no considerable differences compared to skin graft closure were found. The difficulty in distinguishing the origin of donor-site pain between the different nerves or skin grafts emphasizes how little is known regarding this problem so far, and highlights the importance of investigating this in future studies.…”

Section: Discussionmentioning

confidence: 99%

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Bruin

Hundepool

Duraku

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Background: The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. Methods: A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. Results: Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. Conclusion:The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should

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“…The complications of this method are relatively common, and the aesthetic result is sometimes pure. Therefore, a number of alternative methods have been used: full thickness skin graft, local skin flap, tissue expansion, vacuum assisted closure (VAC), cell cultures, synthetic skin substitutes (35)(36)(37)(38)(39)(40)(41)(42)(43)(44). No one of these is ideal and many researches are still focused on the donor site of RFF (32,34).…”

Section: Discussionmentioning

confidence: 99%

Radial Flap in Reconstructions of the Hand - Case Series Study

Vulović

Kozarski

Curcic

et al. 2022

Serbian Journal of Experimental and Clinical Research

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Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2x3.1cm to 9x13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

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Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques

Abstract: The direct closure procedure is quick, simple and can be performed without secondary donor site morbidity. For wound healing, cosmetic and function of the forearm and hand, no inferior results can be measured for the direct procedure compared to the indirect coverage technique.

Cited by 22 publications

References 21 publications

Long‐term donor site morbidity after radial forearm flap elevation for tongue reconstruction: Prospective observational study

Long‐term donor site morbidity after radial forearm flap elevation for tongue reconstruction: Prospective observational study

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Radial Flap in Reconstructions of the Hand - Case Series Study

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