Introduction 1 2 3 4 5 6 7 8 9 10 11 12 Methods Patients All patients who visited the outpatient clinic of the department of otolaryngology/head and neck surgery of the VU Medical Center during the period of March till July 2004 and had a reconstruction of the surgical defect by using a FRFF at least 6 months before were asked to participate in the study. Exclusion criteria were arthritis of the upper extremities or a recent trauma of the wrist and/or lower arm. During this period 69 patients, who underwent such a operation, visited the outpatient clinic. Fifty patients (28 men and 22 women, aged between 26 and 77 years, mean 59.2 ± 11.1 years) met the inclusion criteria. Eight of these 50 patients had had a forearm or wrist injury before surgery (five patients had a wrist fracture, two had a Dupyutren’s contracture and one had surgery because of a ganglion on dorsal side of the wrist), of which four patients at the donor side. None of these patients had pre-existing complaints and/or range of motion disability of the hand or wrist. In 45 patients the left arm was used for the harvest of the FRFF and in five patients the right arm. In three patients the donor side was the side of the dominant hand. Harvest of the flap was done simultaneously with the ablative procedure whenever possible. All patients underwent a preoperative and intra-operative Allen’s occlusion test to rule out inadequate blood supply from the ulnar artery. Fasciocutaneous flaps were raised under a tourniquet in a conventional subfascial or superfascial manner about 2 cm proximal to the wrist skin fold. The superficial radial nerve and branches of the lateral antecubital nerve were preserved. The cephalic vein was used as donor vein. The radial artery was not reconstructed in any patient. The donor defect was closed with a split skin graft (0.6 mm) taken from the upper thigh at the same site. In order to aid healing the arm a pressure dressing of a paraffin gauze and foam was placed over the skin and the arm was immobilized for 7 days in a dorsal hand-to-upper-arm splint. Donor site morbidity questionnaires 1 2 Table 1 n Questions Number of positive answer (%) No complaints 17 (35) Complaints  1. Can you wear a wristwatch or bracelet? 12 (24)  2. Does the hand feel numb? 11 (22)  3. Does the scar itch? 11 (22)  4. Do you experience problems in the cold? 4 (8)  5. Does the appearance bother you? 13 (27) In case of complaints, multiple answers were possible Table 2 n Questions  Number of positive answer (%) No forearm disabilities 38 (75) Disabilities  1. I wake up at night because of my forearm 1 (2.0)  2. I have complaints lying on my forearm  4 (8.0)  3. I have complaints during daily life activities 2 (4.0)  4. I have complaints during movements of my wrist 3 (6.0)  5. I have complaints during leaning on my elbows or hands 3 (6.0)  6. I have complaints with writing (or typing) 1 (2.0)  7. I have complaints holding my wheel of my car or bike 2 (4.0)  8. I have complaints during lifting an object 5 (10.0)  9. I have complaints opening or closing a door 2 (4.0)  10. I rub my wrist or forearm more than once a day 9 (18.0)  11. I am irritable for people in my environment due to my forearm 1 (2.0) Donor site morbidity tests 1 Fig. 1 Inclinometer used for measuring of movements  2 2 3 Fig. 2 Hydraulic dynamometer used for measuring grip strength  Fig. 3 Pinch gauge used for measuring pinch strength  The third test measures the skin temperature of digiti I and V with a Tempcontrol MT 100 KC and probe (Tempcontrol Industrial Electronic Products, Voorburg, The Netherlands) on the skin surface with an accuracy of 0.1°C and a range of −200 to 1350°C. Statistical analyses t p Results 1 2 3 Table 3 Movement extensions, strength and temperature of donor and non-donor wrist and hand   Donor side Non-donor side Mean SD Mean SD Extension 57.3 11.7 59.8 11.0 Flexion 71.1 8.0 70.2 9.2 Ulnar abduction 57.7 8.2 58.9 8.0 Radial abduction 15.3 8.4 14.8 5.1 Pronation 85.4 10.8 85.3 11.0 Supination 79.6 12.2 80.4 12.9 Grip 28.7 10.4 29.9 9.7 Pinch 7.4 2.4 8.0 2.4* Temperature digit I 29.3 3.3 29.4 3.6 Temperature digit V 29.0 3.9 29.1 4.1 p r p r p r p Discussion 13 14 15 16 17 4 7 8 9 18 7 10 17 7 9 10 16 10 16 18 8 4 7 8 9 To diminish donor site morbidity several harvesting and donor site closure technique modifications have been proposed. 7 8 18 19 20 5 17 21 10 22 23 24 Conclusion Donor site morbidity of the radial forearm flap measured by objective functional tests is negligible but in the patient’s perception this is substantial. Subjective measurements show especially problems in cosmesis and sensibility. The present data may be used for solid patient counselling.