This project will assess the impact of immobilisation splinting on radial forearm flap donor site healing to clinically justify safe timeframes for patients to cease forearm immobilisation, and to resume functional use of their upper limb to enable participation in meaningful daily activities.

Patients who are diagnosed with head and neck cancer often require invasive surgical procedures to remove cancerous tissue and reconstructive surgery to repair the affected area. The Radial Forearm Flap (RFF) is one widely used reconstructive skin flap for this purpose.

Despite offering a potential increase in life-expectancy, oncological resection and reconstruction can have an immense impact on patient wellbeing due to loss of function.

The surgical procedure of harvesting (or taking) the RFF from healthy skin on the volar forearm creates a second surgical wound (called a donor site). Immobilisation of the forearm is required post-operatively to provide support for donor site healing. At the Royal Brisbane and Women’s Hospital (RBWH), it is standard practice for the surgeon to immobilise RFF donor sites post-operatively for 7 days in a plaster slab.

After this period and following removal of the plaster slab, variability has been noted in post-operative immobilisation splinting pathways. Currently it is surgeon preference to either, cease the plaster slab and commence forearm/wrist movement, or refer to Occupational Therapy (OT) for fabrication of a custom-made thermoplastic splint (worn to immobilise the wrist for an additional 1-3 weeks).

This variability and lack of consistency in referral pathways has resulted in a combined interest amongst OT and Reconstructive Surgeons to review our current practice. 
 
As Occupational Therapists, optimising the functional independence of patients is fundamental to practice. Unnecessary wrist immobilisation can contribute to reduced occupational performance (the ability to perform activities that make up an individual's lifestyle). Reduced grip and pinch strength, difficulty positioning fingers for function, and increased compensatory movements have been documented in studies examining the effect of wrist immobilisation on upper limb occupational performance. In contrast, OTs also recognise the significance of immobilisation splinting to facilitating wound healing to prevent the occupational limiting effects of delayed wound healing and scarring. 
 
An understanding of the impact of immobilisation splinting on donor site healing is, therefore, crucial to clinically justify safe timeframes for patients to cease forearm immobilisation, and to resume functional use of their upper limb to enable participation in meaningful daily activities.   

This retrospective clinical audit will review medical records of consecutive patients who attended the RBWH over a two-year period (from February 2021 – February 2023) for head and neck cancer resection and reconstruction with a RFF. Consumer engagement will be at the forefront of this project; with a health consumer (who has lived the experience undergoing RFF surgery) forming a member of the project team and with RBWH consumers participating in a consumer satisfaction survey to capture the reported experience of forearm splinting post RFF.

This project aims to identify three specific objectives:

1. Identify the frequency and duration of OT splinting interventions for head and neck patients who have undergone a RFF procedure with subsequent donor site grafting,
2. Identify trends between OT splinting interventions and the clinically documented healing of RFF donor sites, and
3. Understand the lived consumer experience of wearing a splint following RFF surgery.