A simple splint for the radial forearm donor site

( 1996) 34, 533-534

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TECHNICAL NOTE A simple splint for the radial forearm donor site R. 0. M. Marinho, P. McLaughlin Maxillofacial Unit, University College Hospital, Mortimer Market, London, UK

SUMMARY. A simple splint for the radial forearm donor site is described. It can be constructed preoperatively and provides for unlimited re-applications and has been used successfully in 15 consecutive cases.

INTRODUCTION

The radial forearm free flap is a useful and versatile reconstructive adjunct in head and neck surgery in both its fascia-cutaneous and osseo-fascia-cutaneous forms. Dressing of the donor site is most often required to cover a split or full-thickness skin graft and to give rigidity to the forearm where the radial bone has been harvested. To this end most often used is a simple back slab of plaster of Paris, or a fulllength plaster of Paris splint, in cases where a segment of radius has been taken.’ Direct bone stabilizing techniques have also been advocated.’ A recent prospective study has cited radial fracture to result in reduced hand function in all cases.3 Here is illustrated a simple pre-formed thermoplastic splint that has proved useful to us in protection of the radial forearm donor site in 15 consecutive cases.

Figure

-Thermoplastic

forearm

splint

in place.

formed splint. It is easy to construct and can be done so preoperatively saving time at the end of an ordinarily long procedure. The release straps allow easy removal of the appliance such that the wound may be inspected or forearm physiotherapy instituted. The splint can then be reapplied at will. The splint is rigid enough to stabilize the forearm after the raising of a composite radial forearm free flap and avoids the need to replace a back slab or substitute this for a full plaster of Paris. In all our cases patient tolerance has been extremely good and we recommend this as a useful alternative to standard techniques.

TECHNIQUE

The patient is assessed preoperatively by a physiotherapist to assesshand function and forearm muscle bulk. At this visit a thermoplastic forearm splint such as San-Splint, Ezeform (Smith & Nephew, Hull, UK) splinting material is premolded to the patient’s forearm having first applied a thickness of dressing and crepe bandage equivalent to that to be used at operation. Adjustable straps such as self-adhesive Velcro loop are, however, placed on the splint such that this thickness is not crucial and also to allow for postoperative swelling (Figure). At operation the donor site is grafted in the chosen fashion, dressing and bandage applied and the radial forearm splint strapped as shown.

Acknowledgement The authors would like to express their Hopper, Consultant Oral and Maxillofacial in the preparation of this paper.

thanks to Mr Colin Surgeon, for his help

References 1. Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg 1986; 78: l-8. 2. Ilankovan V, Avery BS, Putnam G. A technique to stabilize the radius after harvesting osteocutaneous flaps. Br J Oral and Maxillofac Surg 1994; 32: 50-51.

DISCUSSION

While conventional plaster of Paris dressings remain of use we found certain advantages with the pre533

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3. Richardson D, Fisher SE, Vaughan ED. Brown JS. Radial forearm flap donor site morbidity: A prospective study. J Craniomaxillofac Surg 1994; 22 (suppl 1): 35.

The Authors R. 0. M. Marinho DDS, MSc, FDSRCS Senior House Officer P. McLaughlin BDS, MBBS, FDSRCS, FRCS Senior Registrar

Maxillofacial Unit University College Hospital Mortimer Market London, UK Correspondence and requests for offprints to Mr P. McLaughlin, Consultant Oral and Maxillofacial Surgeon, Maxillofacial Department, The Royal Hospital, Calow, Chesterfield, Derbyshire S44 5BL, UK Paper received 22 November 1995 Accepted 19 February 1996