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Oral CancerNCT05740033

Radial Forearm Donor Site Closure

A study testing Split-Thickness Skin Graft for Radial Forearm Donor Site Closure and Hatchet Flap for Radial Forearm Donor Site Closure in people with Oral Cancer and Oral Cavity Cancer, run by University of British Columbia at 1 site in Canada.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The radial forearm free flap (RFFF) is widely used in head and neck reconstruction. Its thinness, pliability, pedicle length, and vessel size are particularly suited for oropharyngeal and oral cavity reconstruction. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Split-Thickness Skin Graft for Radial Forearm Donor Site Closure and Hatchet Flap for Radial Forearm Donor Site Closure
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteCanada
Study dates
1 Feb 2023to Dec 2025
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 18 or older
  • Oral cavity disease (malignant or benign) requiring radial forearm free flap reconstruction

Who cannot join

  • Serious medical comorbidities including metastatic disease or other contraindications to surgery
  • Any pre-existing condition affecting the use of both hands, including previous major scars
  • Unable or unwilling to complete post-operative questionnaires in English
  • Pregnant or lactating women

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Eitan Prisman, MD, FRCSC contact

6048754126

eitan.prisman@ubc.ca

Canada1 site, 1 recruiting
  • Vancouver General Hospital

    Vancouver, British Columbia, V5Z 1M9

    Tayo Steininger, (604) 875-4111 ext. 22935, tstein12@student.ubc.ca

    Recruiting

Other trials in Canada

About this study

Official title: Functional and Aesthetic Outcomes of Radial Forearm Free Flap Closure Using Split-Thickness Skin Graft vs Primary Closure; a Randomized Control Trial

The radial forearm free flap (RFFF) is widely used in head and neck reconstruction. Its thinness, pliability, pedicle length, and vessel size are particularly suited for oropharyngeal and oral cavity reconstruction. Concerns about aesthetic and functional morbidity at the donor site have given rise to various techniques of closing the donor site, two of which are the split-thickness skin graft (STSG), taken from the thigh, and the hatchet flap, which uses a local flap within the radial forearm. This RCT will determine whether retrospectively reported improvements to aesthetic and functional outcomes for STSG patients are greater compared to hatchet flap patients.

Read the detailed description

The radial forearm free flap (RFFF), introduced by Yang et al. in 1981, is widely used in head and neck reconstruction. Its thinness, pliability, pedicle length, and vessel size are particularly suited for oropharyngeal and oral cavity reconstruction. Since the survival rate of the RFFF has reached more than 95%, the clinical focus has gradually shifted to the postoperative quality of life, particularly in terms of donor site morbidity.

Concerns about aesthetic and functional morbidity at the donor site have given rise to various techniques of closing the donor site of a RFFF. Many possibilities of donor site closures have been described, ranging from direct closure to skin grafting, tissue expansion, use of acellular dermal matrix and local flaps. Each of these techniques has its own advantages and drawbacks and the debate regarding the optimal method for closing the RFFF donor site continues.

Split-thickness skin graft (STSG) is a very thin strip of skin that is typically taken from the upper thigh and is the most commonly used method to cover the forearm after taking the RFFF. Advantages of this technique include reducing the amount of tension that is on the forearm which may lead to a better scar and better mobility while disadvantages include the need of an additional scar on the thigh and possible mismatch of the color of the skin graft when compared to the forearm.

Due to these potential limitations, surgeons have attempted to close the forearm directly by means of local flaps, which use nearby skin, soft tissue, and blood vessels to cover the forearm. The hatchet flap is a triangular local rotation flap, first described by Emmet in 1977, with a greater or lesser degree of advancement and with a back cut at the base of the flap through which it derives its vascular supply. This method may allow for quicker wound healing by primary intention and improved coverage of the tendons which should theoretically decrease donor site morbidity; however, since only tissue from the forearm is used this may lead to increased tension and therefore increased scar formation.

Risks and complications for both types of closure are the same which include bleeding, infection, hypertrophic scars, tendon exposure, divot formation, irregular skin graft surface, prolonged wound healing, and loss of skin graft. There are only a few studies on the functional and visual outcomes of forearm closure after RFFF removal using the hatchet flap or similar local flaps, warranting the need for further studies on these closure techniques.

It is hypothesized that donor site closure using the STSG flap will result in greater functional and aesthetic outcomes for the radial forearm donor site as measured by an improved scores to the 3 given questionnaires. Post-operative complication rates are also hypothesized to be lower for STSG flap closure when compared to hatchet flap closure.

The literature currently remains in a state of clinical equipoise, and at the study site (Vancouver General Hospital) the STSG and hatchet flap are the two most common methods of donor site closure. Based on a retrospective data analysis at the study site, functional and patient-reported scar aesthetic outcomes were improved for STSG flap closure patients when compared to hatchet flap patients. As a retrospective analysis, objective assessments of the scar could not be performed, nor could the immediate post-operative outcomes be taken and compared over a consistent post-operative time frame schedule. This study aims to address this knowledge gap by conducting a parallel-group randomized controlled trial for the study site's two common donor site closure techniques, STSG and hatchet flap.

Being tested
Split-Thickness Skin Graft for Radial Forearm Donor Site Closure, Hatchet Flap for Radial Forearm Donor Site Closure
Keywords
Oral Cancer, Oral Cavity Cancer, Radial Forearm, Donor Site, Surgical Complications
Medical subject headings
Mouth Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Split-Thickness Skin Graft for Radial Forearm Donor Site ClosureProcedure or surgery

    This method is performed by harvesting a 0.014-inch skin graft harvested from the anterolateral thigh on the side of the RFFF to reconstruct the forearm donor site. This skin graft is then used to cover the donor defect. The skin graft is sutured in place with 4-0 chromic suture, and a standard bolster dressing will be applied, and a partial splint will be left in place for five days post-operation.

  • Hatchet Flap for Radial Forearm Donor Site ClosureProcedure or surgery

    The hatchet flap closures will be performed based on prior description by Lane et al. (12), except no drain is placed in situ. A back cut of 3 to 4 cm is made to aid closure (Figure 1). Tension will be minimized by maintaining the wrist in flexion. A mepore dressing will be applied to the donor site post-operatively for two days.

Study groups in NCT05740033
Study groupRoleWhat they receive
STSG armActive comparatorPatient demographics will be recorded during the enrollment visit. During the participant's surgery in which the radial forearm free flap (RFFF) has been used, surgeons will perform a split-thickness thigh graft to close the forearm donor site. A photograph will be taken of the participants' forearm upon the removal of the dressing and splint. On each of the two follow-up clinic visits, another photo will be taken of the forearm scar and patient-reported outcome questionnaires will be provided for completion.
Receives: Procedure: Split-Thickness Skin Graft for Radial Forearm Donor Site Closure
Hatchet flap armActive comparatorPatient demographics will be recorded during the enrollment visit. The hatchet flap closure of the forearm donor site will be performed following the RFFF's usage. A photograph will be taken of the participants' forearm upon the removal of the dressing and splint. On each of the two follow-up clinic visits, another photo will be taken of the forearm scar and patient-reported outcome questionnaires will be provided for completion.
Receives: Procedure: Hatchet Flap for Radial Forearm Donor Site Closure

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. First Michigan Hand Outcomes Questionnaire (MHOQ) Measure

    A questionnaire that measures symptoms, function, aesthetics, and patient satisfaction in regards to the function of their hands. Responses are recorded on a 5-point Likert scale ranging from very good (1) to very poor (5).

    Measured: Measure documented at 1 month post-surgery.

  2. Second MHOQ Measure

    A questionnaire that measures symptoms, function, aesthetics, and patient satisfaction in regards to the function of their hands. Responses are recorded on a 5-point Likert scale ranging from very good (1) to very poor (5).

    Measured: Measure documented between 3-6 months post-surgery.

  3. First Patient and Observer Scale Assessment Scale (POSAS) Measure

    A questionnaire measuring both the patient's aesthetic perception and the trial coordinator's aesthetic and physical assessment of the scar formation along the donor site wound. Responses to questions are measured on a 10-point Likert scale ranging from the worst scarring imaginable (10) to the best scar imaginable (feels like normal skin, not scar tissue; 1).

    Measured: Measure documented at 1 month post-surgery.

  4. Second POSAS Measure

    A questionnaire measuring both the patient's aesthetic perception and the trial coordinator's aesthetic and physical assessment of the scar formation along the donor site wound. Responses to questions are measured on a 10-point Likert scale ranging from the worst scarring imaginable (10) to the best scar imaginable (feels like normal skin, not scar tissue; 1).

    Measured: Measure documented between 3-6 months post-surgery.

  5. First Decision Regret Scale (DRS) Measure

    A questionnaire measuring a patient's decisional regret related to receiving the surgery. Responses are measured on a 5-point Likert scale, ranging from extreme decisional regret (5) to no decisional regret (1).

    Measured: Measure documented at 1 month post-surgery.

  6. Second DRS Measure

    A questionnaire measuring a patient's decisional regret related to receiving the surgery. Responses are measured on a 5-point Likert scale, ranging from extreme decisional regret (5) to no decisional regret (1).

    Measured: Measure documented between 3-6 months post-surgery.

Secondary outcomes (9)
  1. Localized Hematoma at Donor Site

    A severe pooling of blood at the donor site.

    Measured: Patients will be monitored for 6 months post-operatively.

  2. Donor Site Infection

    Infection at the donor site or anywhere along the forearm scar.

    Measured: Patients will be monitored for 6 months post-operatively.

  3. Donor Site Wound Dehiscence

    A re-opening of the donor site wound.

    Measured: Patients will be monitored for 6 months post-operatively.

  4. Donor Site Tendon Exposure

    Exposure of the forearm tendons at the donor site.

    Measured: Patients will be monitored for 6 months post-operatively.

  5. Donor Site Skin Necrosis

    Significant amount of dead or dying skin tissue overlying or abutting the donor site and scar.

    Measured: Patients will be monitored for 6 months post-operatively.

  6. Donor Site Contractures

    A persistent tightening or contraction of skin, ligaments, tendons, or muscles at the forearm donor site.

    Measured: Patients will be monitored for 6 months post-operatively.

  7. Keloid Scarring at Donor Site Wound

    Excessive scar tissue formation along the donor site wound.

    Measured: Patients will be monitored for 6 months post-operatively.

  8. Divot Formation into Skin at Donor Site

    Visible and persistent depressions into the skin surface of the forearm.

    Measured: Patients will be monitored for 6 months post-operatively.

  9. Skin Graft Irregularities at Donor Site

    Additional irregularities such as bumps, roughness, or changes to colour will be recorded.

    Measured: Patients will be monitored for 6 months post-operatively.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Feb 2023
  2. Study start1 Feb 2023
  3. Primary completionDec 2025 (estimated)
  4. Study completionDec 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
The study will have two arms: one with participants receiving a split-thickness skin graft from the thigh to close the radial forearm donor site, and the other using a local (hatchet) flap to close this site. These two arms will be populated randomly and in parallel.
Masking
None (open label)
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05740033
Sponsor's protocol ID
H22-02104
Status last verified
Jun 2025
First submitted
3 Jan 2023
Last updated
12 Jun 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Split-Thickness Skin Graft for Radial Forearm Donor Site Closure and Hatchet Flap for Radial Forearm Donor Site Closure in people with Oral Cancer and Oral Cavity Cancer, run by University of British Columbia at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 12 Jun 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Eitan Prisman, MD, FRCSC (6048754126, eitan.prisman@ubc.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

First Michigan Hand Outcomes Questionnaire (MHOQ) Measure (time frame: Measure documented at 1 month post-surgery.). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jun 2025; AzTrials last refreshed its copy on 28 Oct 2026.

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