The forearm flap: assessment of functional and aesthetic outcomes and quality of life

Abstract 

Purpose

Microvascular surgery frequently represents the only possibility to reach satisfactory cosmetic and functional outcomes after tumor resection in the head and neck. We present the functional and aesthetic outcomes and quality of life (QOL) of our patients who underwent a forearm flap transfer.

Patients and methods

Thirty-one patients who were operated on in the departments of oral and maxillofacial surgery and otorhinolaryngology of the University of Essen participated in the study. Grip power, pinch power, and range of motion at the wrist as well as that in the metacarpophalangeal joints were measured. A sensory assessment including 2-point discrimination, temperature discrimination, and documentation of numbness, paresthesia, and scar pain was performed. The changes in hemodynamics were evaluated with digital optical blood pressure measurement and digital electronic pulse oscillography. Aesthetic satisfaction was investigated with an ordinal scale. Forearm circumference and hair growth on the flap were documented. Quality of life was evaluated with the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3) and H&N35 (Head and Neck Module) after medical treatment and wound healing.

Results

Strength, range of motion, and forearm circumference measurements showed no impairment in comparison with the opposite forearm. Subjective sensory disturbances were found in 31% of the patients but were all regarded as nondisturbing. On the split-thickness graft at the forearm, diminished sensory function could be proven and missing temperature discrimination was revealed in 93%. Evaluation of the hemodynamics showed clinical unremarkable vascularization changes, although slight differences were detectable in the collective. Female (64%) and male (77%) patients rated the aesthetic outcome in their forearm in most cases as good. Hair growth on the transplant could be observed, but it decreased with time and disturbed only a few patients in the oral cavity (14%). In comparison with normative data from a general German population, the QOL assessment showed that patients with tumors stated a similar QOL with regained emotional, cognitive, social, and role functioning. There were significant differences in the symptom scales and single items of the EORTC QLQ-C30 and H&N35. In comparison with a collective of patients with tumors of the oral cavity that were treated with various therapies, no difference was detectable.

Conclusions

Correct planning and elevation presupposed, there will be no clinically relevant finding in strength, motion, and hemodynamics in the forearm and hand after free forearm flap transfer. Sensory findings are present after the operation but decrease with wound healing or are nondisturbing. In this study, the patients with tumors judged the aesthetic result in their forearm in most cases as good. They stated a high QOL with regained emotional, cognitive, social, and role functioning, although they perceived symptoms caused by the tumor and therapy.