Donor-Site Morbidity Following Radial Forearm Free Tissue Transfer in Head and Neck Surgery

Objective: To comprehensively evaluate long-term quantitative and qualitative donor-site morbidity following radial forearm free tissue harvest. Design: A single-centre retrospective cohort study with internal controls was undertaken. Methods: Quantitative measurements of range of motion (ROM) of the forearm, wrist, and digits were performed. Grip and pinch strength and hand dexterity were also evaluated. Qualitative assessment was performed using the Michigan Hand Outcomes Questionnaire (MHQ), a validated quality of life instrument. Main Outcome Measures: Quantitative primary outcome measures were (1) wrist flexion and extension, (2 forearm pronation and supination, and (3) hand dexterity. The qualitative primary outcome measure was overall MHQ score. Results: The operated side demonstrated decreased hand dexterity (p = .008), with no change in wrist and forearm ROM. An increase in ROM of the little finger was found (p = .002). The MHQ demonstrated a perceived decrease in function (p = .031), an increase in pain (p = .045), and no difference in appearance (p = .486). Conclusions: The radial forearm free flap results in measurable quantitative changes in hand function and limited changes in patient perception. Donor-site appearance does not seem to be an important factor.