Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap

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This study sought to characterize the donor-site complications associated with the osteocutaneous radial forearm free flap (ORFFF) used for mandibular reconstruction, as well as to compare donor-site complications between the ORFFF and fasciocutaneous radial forearm free flap (FRFFF).


An Institution Review Board approved, retrospective review identified all ORFFF and FRFFF performed for head and neck reconstruction with a single otolaryngology surgeon at an academic medical center over a 3-year period. Patients requiring an ORFFF underwent harvest of half of the diaphyseal diameter of the radius with prophylactic plating performed by hand surgeons. Donor-site outcomes including infection, skin graft loss, tendon exposure, neuropathy, radius fracture, hardware complications, and need for additional donor-site surgery were compared.


In this study, 25 patients underwent ORFFF harvest, and 52 underwent FRFFF harvest. There was one radius fracture occurring in association with a hardware infection requiring reoperation. No fractures or other major donor-site complications were seen in the FRFFF group. Similar rates of minor complications were noted with skin graft take less than 50% in 4% (n = 1) and 8% (n = 4) with ORFFF and FRFFF, respectively, and tendon exposure in 8% (n = 2) and 15% (n = 8) with ORFFF and FRFFF, respectively. No soft tissue infections or sensory neuropathies were seen. Mean follow-up was 14.2 months for the ORFFF group and 11.7 months for the FRFFF group.


The risk of fracture following ORFFF harvest with prophylactic plating is small. Other donor-site complication rates were similar with both flap techniques.

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