Hwang MS, Britt CJ, Vila PM, et al. - Researchers conducted this multicenter retrospective review to determine which factors are correlated with decreased skin graft take at the donor site in fibula free flaps (FFF) and radial forearm free flaps (RFFF) in head and neck patients. This investigation was carried out at three institutions identifying patients who had free tissue transfer, specifically either FFF or RFFF, between 2007 and 2017. Patient demographics, medical history, and social history have been investigated including age, gender, BMI, smoking status, diabetes and preoperative anticoagulation use. One thousand four hundred fifteen patients underwent a forearm or fibula flap and 938 patients underwent split-thickness skin graft. Of these, 592 patients, average age was 55.7, had adequate details and have been included in the final study. On univariate analysis, patients with diabetes, type of flap, skin graft area, tourniquet use, DVT prophylaxis and casting were significantly linked to decreased skin graft take rate. In a multivariate analysis, diabetes, fibula flaps, an increase in skin graft area, post-operative aspirin, and casting were related to poor rates of skin graft take. Several factors affect skin graft take rate and should be considered for a donor site defect when performing a skin graft.