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Reducing morbidity in the radial forearm flap donor site
A F Bardsley1, D S Soutar, D Elliot
1West of Scotland Regional Plastic and Maxillofacial Surgery Unit, Canniesburn Hospital, Glasgow.
Plastic and Reconstructive Surgery
|August 1, 1990
Summary
Improving radial forearm flap donor sites involves direct closure and modified osteotomy techniques. These surgical changes minimize complications and enhance patient outcomes for free-flap reconstruction.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- The radial forearm flap is a common free-flap technique.
- Donor site morbidity remains a concern.
- Previous studies highlight issues with wound healing and cosmetic outcomes.
Purpose of the Study:
- To investigate the causes of morbidity at radial forearm flap donor sites.
- To identify factors contributing to poor outcomes.
- To evaluate the effectiveness of surgical technique modifications.
Main Methods:
- Review of 100 radial artery free-flap donor sites.
- Categorization into groups based on closure method (skin graft vs. direct closure) and flap type (osteocutaneous).
- Assessment of wound healing, radial artery patency, pain scores, and cosmetic results.
Main Results:
- Wound healing complications were significant in grafted and osteocutaneous flaps.
- Radius fracture occurred in 4/17 osteocutaneous flaps, a major cause of morbidity.
- Radial artery reconstruction had a 50% patency rate.
- Cosmetic results were less favorable in women and with radius fractures.
Conclusions:
- Routine radial artery reconstruction is no longer performed.
- Direct closure of the donor defect, often with an ulnar artery-based flap, is preferred.
- Modified "boat shaped" osteotomy reduces radius fracture risk.
- Surgical technique changes improve donor site acceptability and minimize problems.