Long-term biomechanical analysis of donor site morbidity after radial forearm free flap.
BACKGROUND
Although the radial forearm free flap (RFF) is a commonly used microvascular graft for head and neck reconstruction, long-term biomechanical results regarding donor site morbidity are rare.


METHODS
In a prospective panel study, 32 patients were included. Biomechanical assessment was performed preoperatively, three months postoperatively and two years postoperatively. The primary endpoint of the study was grip strength. In addition, the Mayo wrist score, DASH score (disabilities of the arm, shoulder and hand score), fine motor skill strengths (tip pinch, key pinch, palmar pinch) and the range of motion were analysed. Primary defects were closed with local full-thickness skin grafts (FTSG) from the donor site forearm avoiding a secondary defect site.


RESULTS
In the long-term analysis, grip strength was reduced in both arms. A significant improvement over time was found only for the donor arm. A persistent deficit of tip pinch strength and dorsal extension was recorded. Persistent sensory limitations occurred in four cases. Patient contentment after two years of follow-up was high and daily life routine was not restricted.


CONCLUSIONS
Gross and fine motor skill limitations are reversible short-term effects after RFF harvesting and do not restrict daily routine in the long term. These findings substantiate the value of the RFF as a workhorse in reconstructive surgery.
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Björn
B
Riecke
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Carsten
C
Kohlmeier
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Henri
H
Kreiker
Department of Medical Biometry and Epidemiology (Head: Karl Wegscheider, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Anna
A
Suling
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Alexandre Thomas
AT
Assaf
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Johannes
J
Wikner
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Henning
H
Hanken
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Max
M
Heiland
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Alexander
A
Gröbe
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. Electronic address: c.rendenbach@uke.de.
Carsten
C
Rendenbach
D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000503:physiopathology* / Q000601:surgery*; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000098:blood supply; D018737:Hand Strength / Q000502:physiology; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009068:Movement / Q000502:physiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*
Biomechanical evaluation; Donor site morbidity; Harvesting defect; Radial forearm free flap; Skin graft