Inner Arm Full-Thickness Skin Grafting Versus Split-Thickness Skin Grafting for Radial Forearm Free Flap Donor Sites

BACKGROUND: Radial forearm free flap donor-site coverage remains challenging, and various coverage methods have been reported. Among the available options, ipsilateral inner-arm full-thickness skin grafting (FTSG) has been suggested to provide favorable aesthetic outcomes compared with split-thickness skin grafting (STSG). However, objective quantitative data on color matching and surface texture remain limited. This study compared color matching and texture characteristics between inner-arm FTSG and lateral-thigh STSG groups. METHODS: This retrospective study included 39 patients who underwent radial forearm free-flap reconstruction for head and neck defects and received skin grafting for donor-site coverage. Color disparity between the grafted area and adjacent normal skin was quantified using dE2000 scores, with lower values indicating better color matching. Texture within the grafted area was quantified using gray-level co-occurrence matrix (GLCM) analysis, from which homogeneity, entropy, and contrast were extracted. These parameters were compared between the inner-arm FTSG and lateral-thigh STSG groups. RESULTS: The dE2000 scores were 4.9±3.5 and 8.8±3.8 in the inner-arm FTSG and lateral-thigh STSG (P=0.002) groups, respectively. According to reference values, the dE2000 score was considered "very good" in the FTSG group and "fair" in the STSG group. GLCM texture metrics showed higher homogeneity (0.46±0.10 vs. 0.36±0.11, P=0.004) and lower entropy (6.0±0.6 vs. 6.5±0.8, P=0.043) in the FTSG group, whereas contrast did not differ significantly (108.3±26.3 vs. 110.9±40.7, P=0.814). CONCLUSION: Donor sites covered with inner-arm FTSG demonstrated better color matching and reduced textural irregularity, as reflected by lower entropy and higher homogeneity.