Preoperative Exam Is Not Associated with Postoperative Function following Radial Forearm Free Flap Harvest

Abstract

Background: There is debate on the utility of a preoperative Allen test or ultrasound before radial forearm free flap (RFFF) harvest. This study sought to evaluate correlations between preoperative testing and donor-site morbidity. Methods: A survey of plastic surgery and otolaryngology RFFF patients was conducted at a Midwestern academic center. The modified Cold Intolerance Symptom Severity (modCISS) and Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) instruments were administered. A retrospective chart review was performed to assess perioperative factors. Results: Of 212 RFFFs completed over 7 years, 144 patients were contacted, and 71 patients completed the survey (33% response rate). Preoperative Allen test was negative in 92% of patients (65 of 71). There was no statistical association between Allen test and duplex ultrasound findings (P = 0.19). Cold intolerance screening was positive on 20% of donor arms (14 of 71), with an average positive modCISS score of 39.0 ± 14.7. Disability was reported on the QDASH by 76% of patients (54 of 71), with an average score of 21.0 ± 22.3. There was no statistical correlation between preoperative Allen test or ultrasound classification and modCISS or QDASH score. There was a borderline positive correlation between modCISS and QDASH scores that did not reach statistical significance (r = 0.22, P = 0.067). Operative characteristics also did not predict modCISS or QDASH scores. Conclusions: Following RFFF harvest, donor extremity cold intolerance is reported in 20% of patients, and extremity-related disability is reported in the majority of patients. Preoperative ultrasound and physical examination findings are not predictive of morbidity.

The Central Facial Defect Reconstruction Using a Radial Forearm Free Flap after Malignant Cutaneous Tumor Ablation

“…The flap's pedicle length is among the largest that can be obtained from any free flap. Both the radial artery and cephalic vein boast substantial diameters, providing reliable options for anastomoses [14][15][16]. Moreover, concomitant veins can also be reliably used for venous anastomosis [17].…”

Innovative Strategies in Microvascular Head and Neck Reconstruction

“…For soft tissue reconstruction, a myriad of different donor sites are available, but concerns with donor site morbidity are becoming increasingly scrutinized. The radial forearm flap, which was historically the primary option for a thin pliable donor site, has been criticized more frequently in the modern era with the popularity of alternate donor sites that can avoid a skin graft and potential cold intolerance, and impaired function of the upper extremity [ 77 , 78 , 79 ]. The search for the ideal donor site remains elusive, but likely there is no single donor site that is ideal, and the reconstructive microsurgeon must decide which donor site to use based on the extent and type of defect as well as the patient’s body habitus and available donor sites [ 80 ].…”