Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap

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This study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery.

Study Design

Prospective cohort study.


Plastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France.

Subjects and Methods

Despite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure. Conventional skin grafts for secondary tendon exposure can lead to diminished wrist range of motion and grip strength, with residual pain and cold intolerance. Between 2012 and 2015, we prospectively studied 20 patients with secondary tendon exposure after a forearm radial free flap for head and neck reconstruction. Two techniques of secondary coverage were compared: a reference technique with a secondary full skin graft (10 patients) and a dorsoulnar artery perforator (DUAP) flap (10 patients).


Maximum wrist extension (100%) was observed for the DUAP group compared with only 87% for the skin graft (SG) group (P = .001). An improvement in grip strength (+14 kg) (P = .028) and a decrease in pain or cold intolerance (P = .002) were also observed in the DUAP group, in addition to a better aesthetic appearance.


The perforator flap procedure is an interesting tool in reconstructive surgery. The DUAP flap is a reliable, useful flap for secondary tendon exposure coverage after a radial forearm free flap.

Level of Evidence

III (case-control analytic studies of 1 center).

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