Donor site aesthetic and functional outcomes of radial forearm free flap: a comparison between full-thickness and split-thickness skin grafts

Background: The radial forearm free flap (RFFF) is one of the most common reconstructive choices for head and neck soft tissue defects worldwide. One of the techniques to cover up the donor site defect is based on the use of split-thickness (STSG) or full-thickness skin grafts (FTSG). Methods: Ours is a retrospective study including 36 RFFF reconstructive surgery patients at the University Hospitals of Verona and Parma treated between 2016 and 2020, with more than 6 months’ follow-up. Nineteen patients received a FTSG, locally harvested from the forearm, while 17 a STSG from the thigh. We used two already validated scales for the evaluation of the surgical scars. The first one is the Patient and Observer Scar Assessment Scale that rates vascularity, pigmentation, thickness, relief, pliability, and the surface area, and it incorporates the patient’s assessments of pain, itching, colour, stiffness, thickness, and relief. The second questionnaire was developed by Liu in 2011 to assess the functionality of the donor site from a patient’s perspective. Results: Pigmentation, thickness, relief, and surface area were statistically better in the FTSG than in the STSG group, while, according to the patients, the functional results turned out to be similar. Conclusions: From our experience, the locally harvested FTSG is to be considered the best alternative, with a better aesthetic outcome than the STSG harvested from the thigh and with a higher degree of protection provided to the forearm flexor tendons, without the need for an additional donor site. Level of evidence: Level III, therapeutic study.