Towards optimized donor site closure of radial forearm flaps: A cohort study of two techniques

The radial forearm flap (RFF) is widely used for microvascular reconstruction in the head and neck region, but donor site complications, such as flexor tendon exposure, can impact patient recovery. This study retrospectively analyzed all patients who underwent RFF surgery between April 2017 and July 2023 to identify risk factors for donor site complications and compare the efficacy of two full-thickness skin graft (FTSG) designs: semilunar and VY/Dagger shaped. A matched-pair analysis was performed, and uni- and multivariate analyses were conducted to assess complication risks. Among 401 patients (178 females, mean age 67 ± 12.4 years), 35 % experienced donor site complications. The semilunar FTSG design was identified as a predictor for flexor tendon exposure in both general (p = 0.03) and matched-pair analysis (p = 0.005). Negative pressure wound therapy (NPWT) did not demonstrate superior outcomes compared to conventional methods and was associated with an increased risk of partial graft necrosis (p = 0.03). These findings highlight the importance of FTSG design in RFF donor site closure, with the VY/Dagger shape demonstrating superior outcomes in reducing tendon exposure. Additionally, NPWT does not appear to provide significant benefits in preventing local complications and may not be preferable to conventional wound dressings. These results underscore the role of reflective surgical practice in improving patient outcomes.