Abstract
The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior to the use of RFFF, several authors have reported potentially preventable serious vascular complications. This study included 87 consecutive patients with cancer of the oral cavity and RFFF as the flap of choice who were treated between 2010 and 2020, and compares the results of the Clinical Allen Test (CAT), the Doppler Allen Test (DAT) and the Surgical Allen Test (SAT). The preoperative vascular study found vascular abnormalities severe enough for the surgical team to change the preoperative flap of choice in 39% of patients. The Kappa index showed a weak concordance between the CAT and DAT. The study reflected a total concordance in the preoperative results of the Doppler study and the intraoperative results of the SAT. Due to its excellent agreement with SAT, the DAT would be the preoperative test of choice in patients who are candidates for RFFF. This study of vascular mapping tests with Doppler is intended to inform therapeutic decisions and present methods to gain information that cannot be obtained by physical examination alone.
Highlights
Cancer of the oral cavity is one of the most common malignancies; the main etiological factors are tobacco and alcohol use
The objective of the study was to analyze the findings of preoperative Doppler ultrasonography with the Allen Test in a series of patients whose reconstruction of choice was the radial forearm free flap (RFFF), and to compare the results obtained in the Doppler Allen Test (DAT) with those of the Clinical Allen Test (CAT) and Surgical Allen Test (SAT), evaluating the concordance between the three measures and discussing their clinical implications
34 patients (39%) were deemed serious enough for the surgical team to change the preoperative flap of choice (RFFF of the nondominant hand) by using the radial of the dominant hand (24 cases) or perform an alternative flap (10 cases)
Summary
Cancer of the oral cavity is one of the most common malignancies; the main etiological factors are tobacco and alcohol use. The standard of care is primary surgical resection with or without postoperative adjuvant therapy. Since the development of microvascular free tissue transfer techniques, surgeons have rapidly expanded their ability to resect extensive disease and provide multiple reconstructive options. The radial forearm free flap (RFFF), first described by Yang GF et al [1], has become one of the most used in oral cancer reconstruction [2] due to its versatility, ease of harvesting using a two-team approach, as well as providing a thin, flexible, sensitive skin paddle which is of sufficient size to reconstruct medium-sized defects with a long vascular pedicle. RFFF is associated with significant donor site morbidity; ischemic hand complications (IHCs) are the most feared postoperative morbidities [4,5,6,7,8,9]
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