Preoperative Exam Is Not Associated with Postoperative Function following Radial Forearm Free Flap Harvest.

PURPOSE: There is debate on utility of preoperative Allen's test or ultrasound prior to radial forearm flap harvest. This study sought to evaluate correlations between preoperative testing and donor site morbidity.

METHODS: A survey of plastic surgery and otolaryngology radial forearm flap patients was conducted at a midwestern academic center. The modified Cold Intolerance Symptom Severity (modCISS) and Quick Disabilities of the Arm, Shoulder and Hand (QDASH) were administered. A retrospective chart review was performed to assess perioperative factors.

RESULTS: Of 212 radial forearm flaps completed over seven years, 144 patients were contacted and 71 patients completed the survey (33% response rate). Preoperative Allen's test was negative in 92% of patients (65/71). There was no statistical association between Allen's test and duplex ultrasound findings (p=.19). Cold intolerance screening was positive on 20% of donor arms (14/71), with an average positive modCISS score of 39.0 (SD 14.7). Disability was reported on the QDASH by 76% of patients (54/71), with an average score of 21.0 (SD 22.3). There was no statistical correlation between preoperative Allen's test or ultrasound classification and modCISS or QDASH score. There was a borderline positive correlation between modCISS and QDASH scores that did not reach statistical significance (r=0.22, p=.067). Operative characteristics also did not predict modCISS or QDASH scores.

CONCLUSIONS: Following radial forearm flap harvest, donor extremity cold intolerance is reported in 20% of patients, and extremity related disability in the majority of patients. Preoperative ultrasound and physical exam findings are not predictive of morbidity.