Introduction - Since its 1970’s description, the radial forearm free flap has earned a clearly defined role in the armamentarium of reconstructive head and neck surgery. Three decades later, the donor site remains an intrinsic drawback primarily due to its aesthetic impact, although functional morbidity is significant in a minority of patients. These aspects do not outweigh its significant advantages, but are occasionally reasons for the choice of alternative flaps. Modifications have evolved in an effort to improve these undesirable features and include primary closure, rotation-advancement, proximal paddle placement, FTSG and suprafascial dissection.

Materials and Methods - Acellular dermal allografts (Alloderm – Branchburg, NJ) have been in broad clinical use since their introduction in 1993. Use as the basal layer of a composite graft (patient’s STSG the outer finishing layer) has been described. From July 1999-May 2002, ten patients underwent radial forearm reconstruction of head and neck defects where the donor site was closed with composite technique. Control patients had donor sites closed by conventional STSG technique and were retrospectively selected for comparative defects. Contralateral upper extremities also served as controls. Standardized functional measures were obtained for donor and contralateral extremities.

Results - In long-term follow-up (5/10 patients minimum 1 year), superior aesthetic outcomes are truly remarkable. Objective functional outcomes measures demonstrate a minor comparative advantage for this technique.

Conclusion – A vast improvement in donor site aesthetics is consistently reproducible with minor improvements in functional outcomes measures. The composite grafting technique has significantly refined the state-of–the art in donor site reconstruction for patients undergoing transfer of the radial forearm free flap.