The objective of this study was to determine which free tissue flap donor sites are preferred, in order to optimize patient satisfaction following reconstructive head and neck surgery. The design was a prospective survey at the University of Toronto Medical School. Two hundred sixty-six junior medical students participated (121 males, 145 females, mean age range 18–35 years), with the following cultural representation: Asian (21.3%), English (18.3%), European (17.5%), Indian (13.7%), Jewish (11.0%), mixed (8.7%), Arab (4.6%), African (4.6%), French (1.1%), West Indian (1.1%), Latin American (0.4%). The students completed a Free-Flap Preference Survey after being shown pre- and postoperative images of 4 reconstructive flaps: anterolateral thigh, scapular, radial forearm, and pectoralis myocutaneous. The main outcome measures were mean preference rating scores.
Overall, the medical students ranked the chest as the most preferred body site, followed by the arms, back, and then legs. The back, legs, chest, and arms were ranked with decreasing importance as an acceptable area for a defect. After being shown the pre- and postoperative flap images, the medical students gave the highest rank to the scapular free flap, with the anterolateral thigh, radial forearm, and pectoralis myocutaneous flaps following with decreasing importance. Overall, choice in free-flap preference followed a similar pattern. No significant differences in preference were noted between males and females or between major cultural groups.
Scapular and anterolateral thigh free flaps were ranked highest among medical students contemplating donor-site scars. With increasing numbers of surgeons capable of harvesting free flaps from several areas around the body, consideration of patient free-flap preference may improve quality of life outcome scores.
