The osteocutaneous radial forearm flap has seen limited use in microvascular reconstruction largely because of the high morbidity associated with the donor site. The purpose of this study was to evaluate whether morbidity can be reduced by immediate bone grafting with or without plate fixation of the donor radius.

Over a five-year period (1995-2000), 12 patients underwent reconstruction of mandibular (n=6) or midfacial defects (n=6) with the osteocutaneous radial forearm flap. This experience was retrospectively reviewed to evaluate donor site morbidity after prophylactic bone grafting with and without plate fixation. One patient was lost to follow-up. Mean follow-up for the remaining patients was 21 months (range 6-52 months). Bone grafting of the radius was performed in all patients. Five patients (41.6%) also underwent prophylactic plate fixation. Patients were immobilized post-operatively in a short arm cast followed by splint immobilization for variable lengths of time.

The average width of the harvested radius ranged from 25-60% of the radial circumference (mean of 37%) and the average length taken was 8.1 cm (range 7.5-10cm). Larger radial deficits were treated with plate fixation in addition to bone grafting. Cast immobilization ranged from seven to 17 days (mean 10.3). Mean time for return to daily activity was 3.5 months (range 2-6 months). Complications occurred in five patients. The only major complication occurred in one patient, who sustained a fracture of the donor radius that required plate fixation. Delayed healing of the skin graft occurred in 4 patients; all of which responded to conservative management.

Prophylactic bone grafting of the donor radius with or without plate fixation allows for short periods of cast immobilization and a rapid return to normal daily activity. Large segments of bone may be harvested without a significant increase in the fracture rate. Most complications are minor and respond to conservative management.