Upper Extremity Outcomes in Radial Forearm Free Flap Reconstruction of the Head and Neck

Fasciocutaneous radial forearm free flaps (RFFF) are widely used for head and neck soft tissue reconstruction. Osteocutaneous radial forearm free flaps (OCRFFF) enable bony reconstruction, but concerns for donor site morbidity have limited their use. Long-term donor site outcomes following OCRFFF remain understudied.

Cross-sectional.

Single-institution.

Patients who underwent RFFF or OCRFFF between 2010 and 2023 were surveyed by phone. Upper extremity function was assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) survey (0-100 scale, higher scores indicate greater disability). Patients who were non-verbal or lacked follow-up after 2021 were excluded. QuickDASH scores were analyzed using Wilcoxon rank-sum test. Univariable linear regressions assessed clinical associations.

Survey response rate was 21.7%. The cohort included 26 RFFF, 14 OCRFFF, and 5 patients with multiple radial forearm flaps. At a median time of 3.25 years postoperatively (IQR: 2.2-5.6), OCRFFF patients had higher mean QuickDASH scores (21.6) than RFFF (10.7), suggesting greater functional limitation in OCRFFF cases (P = .12). Overall impairment remained low. OCRFFF patients reported greater difficulties compared to RFFF regarding jar opening (2.4 vs 1.6; P = 0.01), back washing (2.0 vs 1.3; P = .03), and recreational activities (2.5 vs 1.4; P = .02). History of depression was associated with higher QuickDASH scores (coef 12.7, 95% CI: 1.23-24.48).

OCRFFF patients reported greater difficulty in certain task-specific activities compared to RFFF, but overall donor site impairment following forearm free flap reconstruction is minimal. History of depression is associated with worse self-reported upper extremity function.