Radial forearm free flap surgery: a modified skin-closure technique improving donor-site aesthetic appearance

Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Nowadays, the technique for harvesting is standardized, while reconstruction of the forearm donor site defect is somewhat controversial. The authors describe a modified closure technique developed to reduce skin tension that provides subsequent improvement of the cosmetic appearance of the forearm donor site. A series of 43 patients undergoing radial forearm free flap (RFFF) reconstruction is presented, carried out by our ENT department between September 2007 and December 2010. The authors used a modification of the standard triangular full-thickness skin graft (FTSG) technique to close the forearm donor site on 23 patients with a new shape similar to a dagger. Using the Stony Brook Evaluation Scale, the authors analyzed the outcomes of 23 cases employing the dagger-shaped FTSG and compared these with a standard (triangular shaped) reconstructive graft used in 20 earlier patients. The new dagger-shaped graft decreases skin tension and reduces the need of multiple slits in the graft with improved aesthetic outcome; it is an effective method for repair of the forearm donor site with low tension and without the need to harvest the skin graft from the thigh. The technique is simple, reliable and requires no more time than a standard procedure.