Comparison of Radial Forearm Free-Flap Donor Site Dressing Modalities with Temporary Forearm Immobilization

Abstract

Objectives:

1) Compare the success and complication rates of two dressing techniques for radial forearm free-flap donor sites in patients undergoing short term limb immobilization. 2) Recognize the observed benefit of short-term donor limb immobilization in this population.

Methods:

This was a prospective, randomized, controlled study of patients undergoing radial forearm free flap reconstruction of head and neck oncologic post-ablative defects from 2010 to 2013 at a single tertiary care center. Participants’ donor sites were covered with split-thickness skin grafts and were randomized into two arms: static pressure dressing and negative pressure dressing groups. All participants underwent immobilization of the donor arm using a custom-fit removable volar splint for 30 days. Data were collected at 2 postoperative time points.

Results:

Fifty-four patients underwent radial forearm and were enrolled in the study. Twenty-seven patients (50%) received negative pressure dressings, and 27 patients (50%) received static pressure dressings. 100% of enrolled patients were immobilized with custom volar splints. Follow-up data were available for 40 (74%) patients at the time of this writing. The overall complication rate was 20% (n = 8). Within the group of patients with medical co-morbidities, 25% (n = 2) demonstrated donor site morbidity.

Conclusions:

This study reaffirms both techniques as viable methods for covering radial forearm donor sites; however, there are differences between them in cost and convenience for the patient. Additionally, this follow-up study demonstrates that 30-day immobilization may improve donor site outcome regardless of dressing strategy, as evidenced by an overall decrease in donor site morbidity compared to previously published results on non-immobilized patients.