This is a prospective study of 121 consecutive radial septocutaneous flaps harvested by one surgeon. There were 117 successful flaps (97%). The incidence of early return to theatre for potential problems with the flap or the neck wound was 12/121 (10%) and the flap salvage rate was 3/7 (43%). The incidence of three early wound healing complications at the suprafascial donor site were: loss of the skin graft (4%), tendon exposure (3%) and delayed healing (4%). A full-thickness skin graft, usually from the inner upper arm, was used to repair three-quarters of donor site defects. The median time to healing was significantly longer for partial thickness grafts (14 days compared with 10 days, p<0.001). The degree of contraction of the skin graft used to repair the radial defect was significantly less for full thickness than partial thickness grafts (median -21% compared with -33%, p=0.01). There was more relative contraction with larger grafts (p<0.001) and in older patients (p=0.01). The septocutaneous radial flap is reliable. The early morbidity at the suprafascial donor site is relatively low in comparison to that reported at the subfascial donor site.