Radial forearm free flap in head and neck cancer treatment: may dermal substitutes have a role in minimizing the donor site morbidity?

Background: Head and neck cancer treatment often involves the need for extensive soft tissues removal and a subsequent reconstructive phase in order to close the defect. Free flap reconstruction is a safe and effective reconstructive option in head and neck surgery. The radial forearm free flap (RFFF) has been widely used as a reliable reconstructive solution as it provides thin soft tissues, particularly useful to reconstruct the oral cavity and other head and neck regions. The donor site defect resulting after the free flap harvesting inevitably needs to be managed as it can potentially lead to complications or functional and aesthetic impairment. Several closure techniques of the donor site have been described, and among these, two of the most frequently used are the full-thickness skin graft (FTSG) and the cellular dermal matrix (ADM). The aim of this study was to compare the donor site functional morbidity and aesthetic outcomes in two cohorts of patients treated with FTSG and ADM after RFFF reconstruction for head and neck cancer. Methods: Two groups were treated with Integra (group 1) and FTSG (group 2), to manage the radial free flap donor site after head and neck reconstruction. The patients were evaluated with patient self-assessment scale (P-SAS) and observer self-assessment scale (O-SAS) after 1 year and with the disabilities of the arm, shoulder, and hand (DASH) score. Results: A total of 21 patients, aged between 52 and 84 years (mean, 72.3 years) underwent RFFF reconstruction after head and neck cancer resection during the study period. The P-SAS showed an average score of 21.3 in group 1 and 8.3 in group 2 while the O-SAS registered an average score of 18.8 and 9.7, respectively, without statistically significant differences. The DASH scale showed an average score of 28.7 in group 1 and 13.1 in group 2, reaching a statistically significant value (p = 0.5). Discussion: No significant statistical difference in terms of aesthetic outcomes between the use of Integra and FTSG was recorded. The DASH score results suggest that the Integra reconstructive strategy seemed to be associated with the better overall final result when compared with that in the FTSG group. The dermal substitute appeared to provide a faster healing time and can be safe and effective also for wide defects. Conclusions: In our study, we can conclude that the use of the dermal substitute when dealing with RFFF donor site repair can be considered more pleasant both from subjective and objective points of view when compared to the FTSG alone. Level of evidence: Level IV, therapeutic study.