Ulnar versus radial forearm flap in head and neck reconstruction: An experimental and clinical study

Background. To consider the pros and cons of the microvascular ulnar forearm flap compared with its radial counterpart, this study compares the use of these two flaps for head and neck reconstruction. Methods. In 75 patients, 51 ulnar and 24 radial forearm flaps were used. Both groups were compared regarding flap dissection, suitability of the flap for the recipient region, complication rate, and secondary morbidity in the donor region. Furthermore, in 40 healthy volunteers, the thickness of the subcutaneous tissue layer was measured by use of ultrasonography. Results. Flap survival rate, respectively wound healing, in the recipient region showed no differences. Clinical and experimental results demonstrated a thinner subcutaneous layer in the ulnar aspect of the forearm. Compared with its radial equivalent, closure of the ulnar donor side by skin grafting resulted in a significantly lower complication rate. Conclusions. The ulnar forearm flap is favored because of the less hairy skin of the ulnar forearm region, the thinner layer of subcutaneous tissues, and the more conveniently located donor area. The ulnar forearm pedicle is long compared with alternative transplants but shorter than the radial equivalent.