A Technique for Primary Closure of the Free Radial Artery Forearm Flap Donor Site - Early Results

Introduction: Free radial artery forearm flap is a feasible reconstructive option for small defects in the head and neck. However, one of the major drawbacks is covering of the donor site with split-thickness graft, which leads to donor site morbidity, in terms of compromised cosmesis. An alternative strategy to close this defect primarily, utilizing native skin, can be helpful to mitigate this issue. Materials and Methods: We have described a technique of primary closure of donor site defect of the radial forearm flap using a transposition flap in 24 patients. The principle used is to transpose the ulnar skin flap which derives its blood supply from the perforators of the ulnar artery. The efficacy and complications were recorded and described. Results: We were able to close defects of up to 8 cm x 5 cm using this technique. No major complications were reported in any patients. Seven (29.1%) patients had small areas of necrosis at the tri-pointer area and skin edge. All of them healed using conservative measures by secondary intention except one case which required a secondary skin grafting procedure. Hypertrophic scarring was seen in three patients. Conclusions: This technique has many advantages over traditional skin grafting such as improved cosmesis, avoidance of a secondary donor site, and skin graft-associated complications. Further studies to prove the efficacy of this technique with objective function evaluation over a larger cohort are desirable.