title: Radial forearm free flap donor site morbidity: ulnar-based transposition flap vs split-thickness skin graft.
abstract: OBJECTIVE
  To evaluate morbidity associated with the radial forearm free flap donor site and to compare functional and aesthetic outcomes of ulnar-based transposition flap (UBTF) vs split-thickness skin graft (STSG) closure of the donor site.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Tertiary care institution.
  
  
  METHODS
  The inclusion criteria were flap size not exceeding 30 cm(2), patient availability for a single follow-up visit, and performance of surgery at least 6 months previously. Forty-four patients were included in the study and were reviewed. Twenty-two patients had UBTF closure, and 22 had STSG closure.
  
  
  METHODS
  Variables analyzed included wrist mobility, Michigan Hand Outcomes Questionnaire scores, pinch and grip strength (using a dynamometer), and hand sensitivity (using monofilament testing over the radial nerve distribution). In analyses of operated arms vs nonoperated arms, variables obtained only for the operated arms included Vancouver Scar Scale scores and visual analog scale scores for Aesthetics and Overall Arm Function.
  
  
  RESULTS
  The mean (SD) wrist extension was significantly better in the UBTF group (56.0° [10.4°] for nonoperated arms and 62.0° [9.7°] for operated arms) than in the STSG group (59.0° [7.1°] for nonoperated arms and 58.4° [12.1°] for operated arms) (P = .02). The improvement in wrist range of motion for the UBTF group approached statistical significance (P = .07). All other variables (Michigan Hand Outcomes Questionnaire scores, pinch and grip strength, hand sensitivity, and visual analog scale scores) were significantly better for nonoperated arms vs operated arms, but no significant differences were observed between the UBTF and STSG groups.
  
  
  CONCLUSIONS
  The radial forearm free flap donor site carries significant morbidity. Donor site UBTF closure was associated with improved wrist extension and represents an alternative method of closure for small donor site defects.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, ON, Canada. yves.jaquet@chuv.ch
authors.forename: Yves
authors.initials: Y
authors.lastname: Jaquet
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Enepekides
authors.forename: Cory
authors.initials: C
authors.lastname: Torgerson
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D004185:Disability Evaluation; D004954:Esthetics; D005260:Female; D005542:Forearm / Q000098:blood supply*; D058752:Free Tissue Flaps; D018737:Hand Strength; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D011795:Surveys and Questionnaires