Direct closure of radial forearm free-flap donor sites by double-opposing rhomboid transposition flaps: case report

A basic disadvantage of the radial forearm flap is the removal of skin from a functionally important and cosmetically exposed region. The donor site is conventionally repaired by skin grafting. However, this method is associated with complications of graft take and a poor aesthetic appearance. In this report, the authors describe a simple technique for direct closure of a distal forearm flap donor defect, using double-opposing rhomboid transposition flaps. This method is based on the existence of an oblique skin laxity in the distal forearm from the ulnar to the radial side, allowing a double-opposing local flap design. In a 32-year-old female patient, a 6- X 4-cm longitudinally-oriented elliptical skin defect of a radial forearm free flap was succesfully closed directly with the described technique without any complications. This method is a useful alternative for primary closure of small- to medium-sized distal forearm defects.