Assessment of donor site morbidity for free radial forearm osteocutaneous flaps

Authors

  • Catherine F. Sinclair M.D.,

    1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
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  • John P. Gleysteen B.S.,

    1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
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  • Terence M. Zimmermann M.P.H.,

    1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
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  • Mark K. Wax M.D.,

    1. Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
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  • Babak Givi M.D.,

    1. Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
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  • Daniel Schneider M.D.,

    1. Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
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  • Eben L. Rosenthal M.D.

    Corresponding author
    1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
    • University of Alabama School of Medicine, Department of Surgery, Division of Otolaryngology, BDB Suite 563, 1530 Third Avenue South, Birmingham, AL 35294-0012
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  • Accepted for oral presentation at the Annual Meeting and OTO EXPO, San Francisco, September 2011.

Abstract

Purpose: Assessment of donor site morbidity and recipient site complications following free radial forearm osteocutaneous flap (FRFOCF) harvest and evaluation of patient perceived upper limb disability for free radial forearm osteocutaneous versus fasciocutaneous flaps (FRFF). Methods: First a case series was undertaken of 218 patients who underwent an FRFOCF at two tertiary referral centers between February 1998 and November 2010. Outcomes included forearm donor site morbidity and recipient site complications. Second, the disability of the arm, shoulder, and hand (DASH) questionnaire assessing patient perceived arm disability was administered by phone to 60 consecutive patients who underwent an FRFOCF or FRFF. Results: Mean patient age was 63 years with male predominance (62.8%). Median bone length harvested was 8 cm (range, 3–12 cm) with prophylactic plating of the radius following harvest. Donor site morbidity included fracture (1 patient, 0.5%) and sensory neuropathy (5 patients, 2.3%). Mean DASH scores were comparative between groups and to established normative values. Mandibular malunion rate was 3.2% and hardware extrusion at the recipient site occurred in 15.6%. Conclusion: Reluctance to perform FRFOCF by surgeons usually centers on concerns regarding potential donor site morbidity and adequacy of available bone stock; however, we identified minimal objective or patient perceived donor site morbidity or recipient site complications following harvest of FRFOCFs. Mild wrist weakness and stiffness are common but do not impede ability to perform activities of daily living. Data from this and other reports suggest this flap is particularly useful for midfacial and short segment mandibular reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

Ancillary