Purpose: The radial forearm flap has been an important tool in upper extremity reconstruction. The donor site, however, can be a source of morbidity. One method of possible morbidity reduction is a fascia-only flap, leaving donor site skin intact, and applying a skin graft on the flap itself. We report our experience with the radial forearm fascia flap compared with a similar group of fasciocutaneous flaps.

Methods: A review of patients who underwent upper extremity reconstruction with a radial forearm flap was conducted. Records were analyzed for type of reconstruction (fascia, fasciocutaneous), reconstruction complications, and donor site complications.

Results: Thirteen patients underwent radial forearm flap upper extremity reconstruction. Seven were fascia-only, six fasciocutaneous. In the fascia-only group, there were no donor site complications, however, there were 2 partial skin graft losses on the flap, and 3 partial flap necroses, all of which healed spontaneously. In the fasciocutaneous group, there were 2 episodes of graft loss on the donor site, and no flap losses.

Conclusions: While upper extremity reconstruction with a radial forearm fascia flap has potential for donor improvement and improved contour of the flap compared with fasciocutaneous reconstructions, the flap itself can be more tenuous in fascia-only reconstructions.