Free Flap Donor-Site Complications and Management

Abstract

Free flap harvest will occasionally result in donor-site complications and morbidity. Most of these complications are managed simply without producing lingering effects on activities of daily living. However, some patients will sustain limb weakness, gait issues, chronic pain, and nonhealing wounds. Frank preoperative discussion between surgeon and patient is essential to maximize postoperative outcome and manage expectations. Fastidious surgical technique will help minimize the risks of hematoma, seroma, and infection, while newer techniques can help prevent some issues with wound healing, limb weakness, and sensory changes. In this article, we describe the rates of common and rare complications at free flap donor sites, as well as techniques to prevent and manage them.

Keywords

free tissue flaps - reconstructive surgical procedures - morbidity

Ethical Approval

Institutional review board approval not required, as this study is not a human subjects research.

Author Contributions

H.A.: methodology, project administration, writing – original draft, writing – review and editing. J.S.: methodology, writing – review and editing, supervision. D.H.: methodology, writing – review and editing, supervision. All listed authors have provided substantial contributions to the design of the study, data mining, analysis, and interpretation as well as critical revisions to the drafts and final approval for the version to be published.

Level of Evidence

Review and expert opinion.

Publikationsverlauf

Artikel online veröffentlicht:
19. Dezember 2022

• References

• 1 Harris BN, Bewley AF. Minimizing free flap donor-site morbidity. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (05) 447-452
• 2 Nao EEM, Dassonville O, Chamorey E. et al. Head and neck free-flap reconstruction in the elderly. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128 (02) 47-51
• 3 Jones BM, O'Brien CJ. Acute ischaemia of the hand resulting from elevation of a radial forearm flap. Br J Plast Surg 1985; 38 (03) 396-397
• 4 Heller F, Wei W, Wei F-C. Chronic arterial insufficiency of the hand with fingertip necrosis 1 year after harvesting a radial forearm free flap. Plast Reconstr Surg 2004; 114 (03) 728-731
• 5 Ho T, Couch M, Carson K, Schimberg A, Manley K, Byrne P. Radial forearm free flap donor site outcomes comparison by closure. Oto-Head and Neck Surg 2006; 134: 309-315
• 6 Timmons MJ, Missotten FE, Poole MD, Davies DM. Complications of radial forearm flap donor sites. Br J Plast Surg 1986; 39 (02) 176-178
• 7 Liu J, Liu F, Fang Q, Feng J. Long-term donor site morbidity after radial forearm flap elevation for tongue reconstruction: prospective observational study. Head Neck 2021; 43 (02) 467-472
• 8 Lutz BS, Wei FC, Chang SC, Yang KH, Chen IH. Donor site morbidity after suprafascial elevation of the radial forearm flap: a prospective study in 95 consecutive cases. Plast Reconstr Surg 1999; 103 (01) 132-137
• 9 Emerick KS, Deschler DG. Incidence of donor site skin graft loss requiring surgical intervention with the radial forearm free flap. Head Neck 2007; 29 (06) 573-576
• 10 Boorman JG, Brown JA, Sykes PJ. Morbidity in the forearm flap donor arm. Br J Plast Surg 1987; 40 (02) 207-212
• 11 Tillman RM, Smith RB. Successful bone grafting of fracture nonunion at the forearm radial flap donor site. Plast Reconstr Surg 1992; 90 (04) 684-686
• 12 Ahmad FI, Means C, Labby AB. et al. Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction. Head Neck 2017; 39 (09) 1888-1893
• 13 Villaret DB, Futran NA. The indications and outcomes in the use of osteocutaneous radial forearm free flap. Head Neck 2003; 25 (06) 475-481
• 14 Kovar A, Choi S, Iorio ML. Donor site morbidity in phalloplasty reconstructions. Plast Reconstr Surg Glob Open 2019; 7 (09) e2442
• 15 de Bree R, Hartley C, Smeele LE, Kuik DJ, Quak JJ, Leemans CR. Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap. Laryngoscope 2004; 114 (11) 1973-1976
• 16 Chang SC-N, Miller G, Halbert CF, Yang KH, Chao WC, Wei FC. Limiting donor site morbidity by suprafascial dissection of the radial forearm flap. Microsurgery 1996; 17 (03) 136-140
• 17 Hidalgo DA. Fibula free flap mandibular reconstruction. Clin Plast Surg 1994; 21 (01) 25-35
• 18 Ver Halen JP. A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients. Plast Reconstr Surg 2012; 129 (06) 1007e-1008e
• 19 Ling XF, Peng X. What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg 2012; 129 (03) 657-674
• 20 López-Arcas JM, Arias J, Del Castillo JL. et al. The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg 2010; 68 (10) 2377-2384
• 21 Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg 2013; 41 (01) 15-21
• 22 Bai S, Zhang ZQ, Wang ZQ. et al. Comprehensive assessment of the donor-site of the anterolateral thigh flap: a prospective study in 33 patients. Head Neck 2018; 40 (07) 1356-1365
• 23 Urken ML, Bridger AG, Zur KB, Genden EM. The scapular osteofasciocutaneous flap: a 12-year experience. Arch Otolaryngol Head Neck Surg 2001; 127 (07) 862-869
• 24 Patel KB, Low TH, Partridge A. et al. Assessment of shoulder function following scapular free flap. Head Neck 2020; 42 (02) 224-229
• 25 Clark J, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function, and harvest technique. Head and Neck 2008; 30 (01) 10-20
• 26 Harada H, Shimamoto H, Oikawa Y, Kuroshima T, Tomioka H, Hirai H, Tsushima F, Michi Y. Mandibular reconstruction with scapular systems: A single-center case series involving 208 flaps. Plastic and Recon J 2021; 148 (03) 625-634
• 27 Schmedes GW, Banks CA, Malin BT, Srinivas PB, Skoner JM. Massive flap donor sites and the role of negative pressure wound therapy. Otolaryngol Head Neck Surg 2012; 147 (06) 1049-1053
• 28 Smith RB, Henstrom DK, Karnell LH, Chang KC, Goldstein DP, Funk GF. Scapula osteocutaneous free flap reconstruction of the head and neck: impact of flap choice on surgical and medical complications. Head Neck 2007; 29 (05) 446-452
• 29 Adams Jr WP, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg 2004; 53 (01) 6-11
• 30 Rios JL, Pollock T, Adams Jr WP. Progressive tension sutures to prevent seroma formation after latissimus dorsi harvest. Plast Reconstr Surg 2003; 112 (07) 1779-1783
• 31 Müstakim KR, Sodnom-Ish B, Lee HJ, Yoon H-J, Kim SM. Chronic expanding hematoma on latissimus Dorsi free flap donor site grown over 17 years. J Craniofac Surg 2022; 33 (03) e272-e274
• 32 Brooker JE, Wong KY, Malata CM. Spontaneous late haematomas at latissimus dorsi flap donor sites: an unusual complication of breast reconstruction. J Plast Reconstr Aesthet Surg 2015; 68 (02) e40-e42
• 33 Blondeel N, Vanderstraeten GG, Monstrey SJ. et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997; 50 (05) 322-330
• 34 Chang DW, Wang B, Robb GL. et al. Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 2000; 105 (05) 1640-1648