The Radial Forearm Butterfly Flap: A Novel Technique for Oral Cavity Reconstruction With Primary Healing of the Forearm Donor Area

The traditional radial forearm free flap (TRFFF) combined with split-thickness skin grafting (STSG) for repairing oral defects presents unavoidable donor area complications, such as delayed healing and scar hyperplasia. This study introduces a modified radial forearm free flap, known as the butterfly flap, which enables primary closure of the forearm donor area. The study included 35 patients who received the butterfly flap and 40 patients who received TRFFF combined with STSG between March 2022 and March 2024. We compared subjective evaluations of postoperative pain and scar degree in the donor area as well as objective assessments of preoperative and postoperative grip strength, key pinch strength, and postoperative donor area complications between the two groups. The delayed wound healing rate was 5.7% (2/35) in the butterfly flap group and 25.0% (10/40) in the TRFFF group, with a significant difference between the two groups (p = 0.023). The postoperative scar score of the donor site in the butterfly flap group was significantly lower than that in the TRFFF group (5.57 ± 1.24 vs. 7.10 ± 1.24, p < 0.05). No significant differences were observed in pain severity scores, incidence of other donor complications, and changes in grip and key pinch strength. The radial forearm butterfly flap can directly close the donor area wound without skin grafting, reducing scar formation and the delayed healing rate of the donor area.