title: Suprafascial Harvest of the Radial Forearm Free Flap Decreases the Risk of Postoperative Tendon Exposure.
abstract: OBJECTIVE
  To determine if suprafascial harvest of the radial forearm free flap improves postoperative donor site outcomes compared to subfascial harvest.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  Forty-six patients underwent reconstruction of a head and neck defect with a radial forearm free flap (RFFF). Subfascial harvest of the RFFF was performed in 25 (53%) patients and suprafascial harvest performed in 22 (47%) patients. All donor sites were covered with a split thickness skin graft and a bolster that remained in place for 6 days. Postoperative tendon exposure at the donor site occurred in 5 (20%) of the patients in the subfascial group and in 0 (0%) of the patients in the suprafascial group ( P = .05; Fisher's exact test). Average tourniquet time was 117 minutes in the subfascial group and 102 minutes in the suprafascial group. Hematoma formation occurred at the donor site in 2 (8%) and 1 (5%) patients in the subfascial and suprafascial groups, respectively. There were no complete or partial flap losses in either group.
  
  
  CONCLUSIONS
  Suprafascial harvest of the RFFF decreases the risk of postoperative tendon exposure. The suprafascial harvest technique does not increase harvest time or donor site complications, nor does it negatively impact flap vascularity.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Shonka
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Nikita V
authors.initials: NV
authors.lastname: Kohli
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Milam
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Jameson
mesh_terms: D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D000071938:Fasciotomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005542:Forearm; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016038:Skin Transplantation; D013710:Tendons; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: head and neck reconstruction; miscellaneous; otolaryngology; radial forearm free flap; reconstruction; rhinology; wound healing