Donor Site Morbidity in Free Flap Reconstruction

Donor site morbidity encompasses the range of complications arising at the tissue harvest location following free flap reconstruction. While free flaps offer reliable vascularised tissue transfer for complex defects, the sacrifice of donor tissue can lead to functional deficits, altered sensation, chronic pain and aesthetic concerns. Common harvest sites such as the radial forearm or anterolateral thigh are valued for their versatility, yet may leave patients with reduced grip strength, limited range of motion, neuropathic discomfort and conspicuous scarring. These sequelae can compromise daily activities, prolong rehabilitation and diminish patient satisfaction. Over the past decade, refinements in microsurgical technique, advances in wound closure and evolving rehabilitative protocols have sought to mitigate these effects. Surgeons now assess perfusion dynamics preoperatively, employ local flap or graft alternatives to optimise closure, and apply novel dressings to enhance early function. A comprehensive understanding of donor site morbidity is essential to balance reconstructive success with quality of life and to guide informed consent and postoperative care.

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Donor Site Morbidity in Free Flap Reconstruction publication trend

The graph below shows the total number of articles in donor site morbidity in free flap reconstruction across all publications each year (not limited to Nature Index journals).

Technical terms

Radial forearm free flap (RFFF): A microsurgical transfer of skin, fascia and vessels from the forearm based on the radial artery for reconstructing distant defects.

Ulnar forearm free flap (UFFF): Similar to RFFF but based on the ulnar artery, offering alternative vascular anatomy and tissue characteristics.

Split-thickness skin graft (STSG): A graft comprising the epidermis and part of the dermis, commonly used to cover donor sites with rapid take but potential for contour irregularity.

Full-thickness skin graft (FTSG): A graft including the entire dermis, providing superior cosmetic outcome at the expense of limited donor-site area and higher requirement for primary closure.

Ulnar-based transposition flap (UBTF): A local forearm flap rotated around the ulnar artery to cover the donor defect without grafting.

Negative pressure wound therapy (NPWT): A dressing technique that applies controlled subatmospheric pressure to a wound or graft site to enhance perfusion and reduce oedema.

References

1. Optimizing Wound Healing in Radial Forearm Donor Sites: A Comparative Study of Ulnar-Based Flap and Split-Thickness Skin Grafting. Biomedicines (2025).
2. Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review. Journal of Plastic Reconstructive & Aesthetic Surgery (2021).
3. Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors. Journal of Otolaryngology (2014).
4. Long-Term Donor Site Morbidity and Flap Perfusion Following Radial versus Ulnar Forearm Free Flap—A Randomized Controlled Prospective Clinical Trial. Journal of Clinical Medicine (2022).
5. Is Hyperspectral Imaging Suitable for Assessing Collateral Circulation Prior Radial Forearm Free Flap Harvesting? Comparison of Hyperspectral Imaging and Conventional Allen’s Test. Journal of Personalized Medicine (2021).