Short-Term Patient-Reported Outcomes of Donor Site Morbidity After Radial Artery Forearm Free Flap in Oral Cancer Reconstruction Surgery

Introduction: The radial artery forearm free flap (RAFF) is a standard option for reconstruction after resection of oral cancer, but donor site morbidity remains a concern, and early patient-reported outcomes in advanced disease are poorly described.We assessed short-term donor site morbidity after radial forearm free flap reconstruction in patients with stage IVA oral cancer.The primary objective was to quantify patientreported donor site morbidity, using a 14-item questionnaire and a derived morbidity score.The secondary objectives were to describe clinician-assessed donor site findings (scar characteristics, sensation, grip, and forearm circumference).Materials and methods: In this descriptive cross-sectional study, 11 right-hand-dominant patients whose donor sites were closed with a split-thickness skin graft completed a 14-item questionnaire (five cosmesis and sensibility items and nine forearm disability items, each scored 1 to 4) and underwent a clinical examination of the forearm at a median of eight months after completion of treatment.A morbidity score from 0 (no complaints) to 100 (severe) was calculated.Proportions are reported with exact 95% confidence intervals (CI), and nonparametric tests were used for exploratory comparisons because of the small sample.Results: The mean age was 59.9 years (standard deviation (SD): 5.8), and seven patients (63.6%) were women.The flap was taken from the nondominant arm in seven patients.Hand numbness (six patients: 54.5%) and concern about donor site appearance (four patients: 36.4%) were the commonest complaints.Two patients (18.2%) reported difficulty lifting heavy objects, and no patient reported itching, difficulty moving the wrist, or difficulty writing.Hand grip was normal in all patients, and forearm circumference did not differ between arms (Wilcoxon signed-rank: W = 12.5; p = 0.31).The mean morbidity score was 6.7 (SD: 7.2); three patients (27.3%) had no complaints, and nine (81.8%) would undergo the procedure again.Complaints did not differ significantly by sex or arm dominance.Conclusions: Short-term donor site morbidity was characterized by low severity, though hypoaesthesia, and aesthetic concerns regarding scarring were prevalent.As these descriptive findings are derived from a limited, single-institution cohort, further validation in larger multicenter studies is warranted; nonetheless, these data may refine preoperative patient counseling.