Beyond the Scar: Exploring Functional Outcomes, Donor Site Morbidity and Cosmesis for Radial Forearm Free Flap Reconstruction for Head and Neck Cancer

Background Surgical reconstruction for head and neck cancer (HNC) using a radial forearm free flap (RFFF) allows surgeons to autotransplant vascularised tissue to repair soft tissue defects. This study investigated donor‐site morbidity, cosmesis and functional outcomes following RFFF transfer. Methods Individuals who had undergone a RFFF between 1 January 2010 and 31 December 2022 at either the Illawarra Shoalhaven Local Health District or Chris O'Brien Lifehouse/Royal Prince Alfred Hospital in New South Wales, Australia were invited to participate. Donor‐site function and cosmesis were assessed via telephone interview using Disabilities of the Arm, Shoulder and Hand (DASH) and Patient and Observer Scar Assessment Scale (POSAS) questionnaires, respectively. Remoteness of residence was assigned according to Modified Monash Model (MMM) codes based on postcode. Inpatient postoperative complications were extracted from medical records. Results Fifty‐eight individuals participated (total of 62 RFFF procedures), with most ( n = 45, 73%) from MM1 (metropolitan) areas. The average age was 69.5 years, with slightly more females ( n = 33, 53%). The majority ( n = 49, 79%) had squamous cell carcinoma (SCC) and 69% ( n = 43) had surgery alone. There were no significant differences in overall DASH or POSAS scores, or complication rates by remoteness. Evaluation of individual DASH components revealed impacts on grip and strength activities, which were greater amongst rural patients ( p < 0.05). Conclusions Cosmesis, donor‐site morbidity and overall function after RFFF reflected a low level of deleterious impact from surgery. Rural patients however reported greater disability with grip and strength activities. Consideration of patient lifestyle and social circumstances in flap selection may minimise such impacts.