Oral Cancer (2018) 2:27–35
Comparison of the outcome of suprafacial and subfacial dissection
of radial forearm in head and neck reconstruction
Anil Kumar Desai
· Niranjan Kumar
· Vividha Singhania
· K. B. Srikanth
· Avinash Prabhu
Received: 29 September 2017 / Accepted: 21 February 2018 / Published online: 12 March 2018
© Springer International Publishing AG, part of Springer Nature 2018
Purpose Radial forearm ﬂap is a versatile and reliable tool in oral cancer reconstruction. However, a spectrum of donor-site
deﬁcits following harvest of this ﬂap has been reported. Several surgical technique has been proposed to improve skin graft
take and tendon exposure and subsequent undesirable results at donor site.
Objective The study was conducted to compare the donor-site morbidity associated with suprafacial radial forearm ﬂap to
that with subfacial donor site in oral cancer reconstructive surgery at our unit.
Methodology A total of 20 patients were included in the study and were categorized into suprafacial group and subfacial
group. The donor-site morbidity was assessed both objectively and subjectively at 15 days, 1 month and 4 months postop-
eratively. The subjective evaluation was done using patient-related wrist elevation and patient and observer scar assessment.
Results The suprafacial showed 80% of patients with complete graft uptake when compared to 50% in subfacial group and
20% showed delayed healing in subfacial group. Range of motion and grip strength was found higher in suprafacial group.
Subjective evaluation revealed a better aesthetic out come in suprafacial group. The subjective evaluation for pain and func-
tion did not reveal a statistically signiﬁcant diﬀerence between two groups.
Conclusion The study of donor-site morbidity clearly demonstrates the superiority of suprafacial technique over subfacial
Keywords Radial forearm · Flap · Suprafascial · Subfascial · Goniometer · Dynamometer
Radial forearm ﬂap was ﬁrst described in 1981 by Yang
et al. . It is considered as the new workhorse in micro-
vascular reconstruction of various head and neck surgical
defects . It is a versatile and reliable tool in oral cancer
reconstruction. Much like its reliable and unquestionably
useful pedicled predecessors (that is pectoralis major
myocutaneous ﬂap), the radial forearm has several distinct
advantages. However, in common with all forms of local
and distant ﬂap reconstructions, these advantages have to be
balanced against potential complications at the donor site.
A spectrum of donor-site deﬁcits following harvest of this
ﬂap has been reported. Compromised healing of the radial
donor site is a signiﬁcant cause of postoperative morbid-
ity. Tendon exposure and adhesion formation cause delayed
healing, poor cosmesis, and loss of function [3, 4]. Several
surgical techniques have been proposed to improve skin graft
take and tendon exposure and subsequent undesirable results
at donor site.
* Anil Kumar Desai
K. B. Srikanth
Department of Cranio-facial Surgery and Research
Centre, S. D. M. College of Dental Science and Hospital,
Dharwad 580009, India