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Updated: May 7, 2026
Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
Immediate bone grafting and plating of the radial osteocutaneous free flap donor site
Philip J Torina1, Evan Matros, Edward A Athanasian
1From the *Division of Plastic and Reconstructive Surgery, and †Department of Surgery, Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
Background:
The primary shortcoming of the osteocutaneous radial forearm flap (ORFF) in head and neck reconstruction is the high incidence of fracture at the donor site. Although several prophylactic measures are reported, combined plating with iliac crest bone graft (ICBG) of the donor site has not been previously described. Outcomes and rationale for this method of radius reconstruction are described.
Methods:
Retrospective review of a prospectively maintained database identified 23 consecutive patients who underwent head and neck reconstruction using an ORFF. Flap features, method of donor-site reconstruction, and complications were evaluated.
Results:
The initial 7 patients from the series had no intervention at the radius donor site. The next 7 patients had ICBG only, whereas the final 9 patients had both plating and ICBG placed at the donor site. The mean cross-sectional diameter and length of radius bone harvested was 30% by 7 cm, 33% by 8 cm, and 53% by 9 cm for the 3 groups, respectively. Fracture rates for the 3 groups were 29%, 14%, and 0%. There were no iliac crest donor-site complications.
Conclusions:
Plating combined with ICBG is a safe and effective method for radius donor-site reconstruction. This technique maximizes both early and late strength of the radius while allowing for harvest of greater segments of bone. Decreased donor-site morbidity combined with more bone available for use in oromandibular reconstruction may tip the risk-benefit scale in favor of more widespread ORFF use.
