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Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

The use of the radial forearm-free flap is a well-established and reliable reconstruction method in head and neck surgery. Usually, the defect of the donor site is covered with full or split-thickness skin grafts. Since 09/2013, a direct closure of the radial forearm donor site has been performed at the ENT University Hospital Leipzig to avoid secondary donor site morbidity. However, few data are available in the literature on long-term cosmetic and functional results compared to the established indirect donor site defect coverage.

Methods

This study investigated patients with radial forearm-free flap harvest from 01/2012 until 03/2015. A total of n = 39 patients were included, with n = 18 being operated by indirect (group 1) and n = 21 by direct closure technique (group 2). For the validation of surgical revisions and wound healing disorders, we carried out clinical investigations as well as interviews. The “POSAS Observer and Patient Scale” was used for assessing the cosmetic outcome and the “Michigan Hand Outcome Questionnaire (MHQ)” for functional criteria.

Results

Group 2 showed an increased rate of wound healing problems, however it was not statistically different compared to group 1. Revision surgery was necessary in both groups only each in one case. Using the POSAS, there were no significant differences between both groups in the observer scale for the items vascularity, pigmentation, thickness, relief, pliability, surface area and even for pain, scar itching, color, stiffness, thickness and relief in the patient scale. The functional results (MHOQ) also showed no significantly inferior results for group 2.

Conclusions

The direct closure procedure is quick, simple and can be performed without secondary donor site morbidity. For wound healing, cosmetic and function of the forearm and hand, no inferior results can be measured for the direct procedure compared to the indirect coverage technique.

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Authors and Affiliations

  1. Clinic of Otolaryngology, Head and Neck Surgery and Department of Head Medicine and Oral Health, University Hospital Leipzig, Liebigstr. 12, 04103, Leipzig, Germany

    Markus Pirlich, Iris-Susanne Horn, Christian Mozet, Andreas Dietz & Miloš Fischer

  2. Clinic of Otolaryngology, Head and Neck Surgery, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany

    Iris-Susanne Horn, Christian Mozet & Miloš Fischer

  3. Clinic of Neurology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany

    Mandy Pirlich

Authors
  1. Markus Pirlich
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  2. Iris-Susanne Horn
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  4. Mandy Pirlich
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  5. Andreas Dietz
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Correspondence to Markus Pirlich.

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All authors declare no conflicts of interest.

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Informed consent was obtained from all individual participants included in the study.

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Pirlich, M., Horn, IS., Mozet, C. et al. Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques. Eur Arch Otorhinolaryngol 275, 1219–1225 (2018). https://doi.org/10.1007/s00405-018-4908-5

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  • DOI: https://doi.org/10.1007/s00405-018-4908-5

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