Barrel-shaped design of the forearm free flap for lower lip reconstruction: a pilot case-control study

Nan-Chin Lin,Kuo-Yang Tsai,Shih-Lung Lin

doi:10.1186/s12893-020-00792-x

Nan-Chin Lin, Kuo-Yang Tsai + Show 1 more

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https://doi.org/10.1186/s12893-020-00792-x

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Abstract

BackgroundRadial free forearm flaps is indicated patients with total or near-total defects in their lower lip. The purpose of our study was to evaluate a simple and effective barrel-shaped design of the radial free forearm flap for lower lip reconstruction and to compare its clinical outcomes with those of a conventional rectangular shaped free forearm flap.MethodsTwenty-two patients with a lower lip carcinoma who underwent radial forearm free flap reconstructive surgery were enrolled in this study between January 1, 2012, and December 31, 2017. A barrel-shaped design of radial forearm free flap for reconstruction was used in 8 patients (case group), and a rectangular design was used in 14 patients (control group). The patients’ quality of life was evaluated preoperatively and postoperatively in all the patients using the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-HN35) questionnaire. We analyzed the differences in the EORTC QLQ-HN35 scores pre- and postoperatively between the case and control group.ResultsThe patients in the case group had better outcomes in swallowing, speech, social eating, social contact, and dry mouth than the control group at 1-year follow-up (P < 0.05).ConclusionsThe use of a barrel-shaped design free forearm flap for lower lip reconstruction is an effective procedure and can achieve better results than the use of rectangular free forearm flap.

Highlights

Radial free forearm flaps is indicated patients with total or near-total defects in their lower lip
The barrel-shaped design of the radial forearm free flap for reconstruction was used in 8 patients and the rectangular design was used in the remaining 14 patients
The barrel-shaped free forearm flap can achieve good oral competence and enable patients to return to a normal diet with one-stage reconstructive surgery without any additional suspension procedures

Summary

Introduction

Radial free forearm flaps is indicated patients with total or near-total defects in their lower lip. In cases of total or near-total defects in the lower lip, Sakai et al (1989) have indicated the use of radial forearm free flaps in reconstructive surgery. The method first described by Sakai et al [2] has been used and modified by other researchers [4,5,6]. This type of reconstructive procedure has disadvantages, including sagging in the middle portion of the flap, when the patients are eating or drinking which in turn causes drooling [4, 5]. Studies have reported that approximately 15% of patients have no palmaris longus which is the most used muscle for suspension procedures [7, 8]

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