title: Reduction of donor site morbidity of free radial forearm flaps: what level of evidence is available?
abstract: BACKGROUND
  The radial forearm free flap (RFFF) is the most commonly used free flap in head and neck reconstructive surgery. However, despite excellent results with respect to the site of reconstruction, donor site morbidity cannot be neglected. This review summarizes the current state of knowledge and analyzes the level of evidence with regard to perioperative management of the reduction of RFFF donor site morbidity.
  
  
  METHODS
  The medical Internet source PubMed was screened for relevant articles. All relevant articles were tabulated according to the levels of scientific evidence, and the available methods for reduction of donor site morbidity are discussed.
  
  
  RESULTS
  Classification into levels of evidence reveals 3 publications (1.5%) with level I (randomized controlled trials), 29 (14.0%) with level II (experimental studies with no randomization, cohort studies, or outcome research), 3 (1.5%) with level III (systematic review of case-control studies or individual case-control studies), 121 (58.7%) with level IV (nonexperimental studies, such as cross-sectional trials, case series, case reports), and 15 (7.3%) with level V (narrative review or expert opinion without explicit critical appraisal). Thirty-five (17.0%) articles could not be classified, because they focused on a topic other than donor site morbidity of the RFFF.
  
  
  CONCLUSIONS
  Although great interest has been expressed with regard to reducing the donor site morbidity of the workhorse flap in microvascular reconstruction procedures, most publications fail to provide the hard facts and solid evidence characteristic of high-quality research.
authors.forename: Denys J
authors.initials: DJ
authors.lastname: Loeffelbein
authors.forename: Sammy
authors.initials: S
authors.lastname: Al-Benna
authors.forename: Lars
authors.initials: L
authors.lastname: Steinsträßer
authors.forename: Robin M
authors.initials: RM
authors.lastname: Satanovskij
authors.forename: Nils H
authors.initials: NH
authors.lastname: Rohleder
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.forename: Marco R
authors.initials: MR
authors.lastname: Kesting