Suprafascial vs. Subfascial Radial Forearm Free Flap in Head and Neck Reconstruction: A Comparative Study

초록

Purpose: Radial forearm free flaps (RFFF) are widely used for head and neck reconstruction because of their thin, reliable tissue. However, conventional subfascial elevation often causes donor site complications, especially tendon exposure. Suprafascial dissection has been proposed to reduce these problems without affecting flap survival. This study compared the safety and outcomes of suprafascial and subfascial RFFF in head and neck reconstruction. Methods: A retrospective review was performed on 32 patients treated with RFFF between 2006 and 2021. Patients were grouped by flap elevation technique such as subfascial dissection (Group A) and suprafascial dissection (Group B). The comparison between the two groups was divided into two categories. The first concerned donor site complications, such as treatment duration, delayed healing (including partial graft loss, the need for secondary skin grafting, and tendon exposure). The second concerned recipient site complications, including wound dehiscence, hematoma, and partial flap loss. Results: Donor site morbidity was greater in the subfascial group, with a longer treatment period and more frequent delayed healing and tendon exposure. No cases of tendon exposure were observed after suprafascial elevation, which also facilitated faster recovery. Recipient site complications, including wound dehiscence, hematoma, and partial flap loss, occurred at similar rates in both groups without statistical significance. Conclusion: Suprafascial RFFF achieved similar flap stability compared with the conventional subfascial method. Donor site complications, especially tendon exposure, were less frequent, and the treatment period was shorter. Therefore, suprafascial elevation can be considered a safe and practical option for head and neck reconstruction