Frontotemporal reconstruction with hydroxyapatite cement and the radial forearm free flap.

Abstract

Contemporary surgical reconstruction of extensive frontal and temporal bony and soft tissue defects requires the use of myocutaneous free flaps. These flaps are associated with donor site morbidity, lengthy operative time, and lack of rigid protection for the brain. To circumvent these problems, we introduce a new surgical technique for reconstruction of frontotemporal defects. To evaluate and discuss hydroxyapatite and radial forearm free flap (RFFF) reconstructive options for patients with soft tissue and bony defects in the frontal and temporal regions after ablative cancer surgery. Eight consecutive patients with extensive soft tissue and bony defects in the frontal and temporal regions underwent primary reconstruction with hydroxyapatite cement for replacement of bone, and the RFFF for soft tissue coverage. Patient follow-up ranged from 6 to 48 months. Outcome was determined in terms of immediate and delayed postoperative complications, donor site morbidity, and long-term aesthetic results. Excellent bony and soft tissue contour restoration was achieved in all patients. The bony and soft tissue volume was maintained throughout the follow-up period. One patient had a stroke. No other postoperative complications were encountered. Morbidity from RFFF harvest was minimum. The combination of hydroxyapatite cement and the RFFF is a viable alternative to the conventional myocutaneous free flap reconstruction of extensive frontotemporal defects. This technique provides excellent aesthetic results, provides rigid protection for the brain, produces minimal and well-tolerated donor site morbidity, and reduces operative time by avoiding intraoperative changes in patient position.