Outcomes of Radial Forearm Free Flap Closure With Split-Thickness Skin Graft Versus Primary Closure

Background: This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site. Methods: Patients with RFFF (2015–2020) were retrospectively identified. Those willing to participate in patient-reported outcomes (PRO) filled out Patient-Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ). Results: 198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165). Conclusions: STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure. Level of Evidence: 3 Laryngoscope, 134:4266–4273, 2024.