Outcomes of Radial Forearm Free Flap Closure With Split-Thickness Skin Graft Versus Primary Closure

BackgroundThis study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site.MethodsPatients with RFFF (2015-2020) were retrospectively identified. Those willing to participate in patient-reported outcomes (PRO) filled out Patient-Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ).Results198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165).ConclusionsSTSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure.Level of Evidence3 Laryngoscope, 2024 This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flapdonor site using the Patient-Observer Scar Assessment Scale and Michigan Hand Outcome Questionnaire. In total, 81 patients participated in the study (39 STSG patients and 42 hatchet flap patients). STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure. image