Forearm Fascial Flap Research Articles

Nasal reconstruction with a prefabricated free flap

We report a case of a 61-year-old patient who presented to us for nose and cheek reconstruction post multiple excisions of an extensive recurrent basal cell carcinoma (BCC) of the right cheek and most of the nose. Nasal reconstruction was achieved with a free helical rim flap for the right ala and a staged prefabricated radial artery forearm free fascial flap. We were successful in producing a very favorable esthetic result and restoring nasal function.

The use of perforator radial fascial forearm flap in the management of recurrent carpal tunnel syndrome

Background Management of recurrent carpal tunnel syndrome is considered a challenge for hand surgeons. We treated this clinical entity using a novel technique involving pedicled tissue transfer using a perforator-based radial-sided fascial forearm flap. Patients and methods The procedure was performed in six patients, all of whom had undergone previous failed surgery to release the median nerve and a period of initial relief not less than 3 months. Results At an average of 24 months following the procedure, all patients reported symptomatic improvement with complete resolution of night-time symptoms. No patient reported worsening of symptoms postoperatively; however, subjective paresthesias persisted in three of the six patients. Objective assessment revealed complete resolution of Tinel's sign in half of the patients and significant improvement in the other half. The average two-point discrimination improved from 10 mm preoperatively to 6 mm postoperatively, and the average postoperative grip strength improved from 11 to 20 kg. Conclusion The radial perforator-based fascial forearm flap is a useful option in the management of selected patients with recurrent carpal tunnel syndrome.

Modified free radial forearm fascia flap reconstruction of lower extremity and foot wounds: optimal contour and minimal donor-site morbidity.

Free tissue transfer is commonly required for reconstruction of distal third lower extremity injuries. Injuries involving the dorsal surface of the foot require thin pliable flaps. Musculocutaneous flaps are often too bulky to accommodate shoewear. Fasciocutaneous flaps, while an improvement, need secondary contouring procedures. The modified radial forearm fascial flap (MRFFF) may offer an alternative. Twelve patients with distal third lower extremity wounds were reconstructed with MRFFF + split thickness skin graft. The modification in flap design leaves fascia radial to the pedicle unharvested, preserving sensibility of the dorsoradial aspect of the hand. Flaps were covered with a skin graft after inset. Donor sites were closed primarily. Nine wounds were traumatic-five with exposed hardware, one burn, one diabetic ulcer, and one wound dehiscence following sarcoma resection + radiation. Out of 12, 11 limbs were salvaged at 1 to 2 years follow-up. All patients ambulated on the reconstructed leg and wore a shoe comfortably. Average time to weight bearing was 2 months. The donor site was limited to 25-cm scar on the volar forearm. No persistent motor/sensory deficits occurred in donor arms. MRFFF is an excellent flap for reconstruction of the distal lower extremity. Flap contour allows excellent shoe-fitting without secondary revisions. Replacement of the adipocutaneous flap on MRFFF donor site eliminates the need for a conspicuous donor-site skin graft. The ulnar orientation of the harvested fascia prevents sensory loss in the dorsal hand. The MRFFF provides the ideal replacement of "like with like" for selected distal lower extremity wounds.

Microsurgical reconstruction of soft tissues of knee region in absence of local plastic resources in preparation for arthroplasty

A new method of microsurgical reconstruction of soft tissues defects of a knee in the conditions of inability to form pedicled flaps of thigh and shin has been offered. Prefabricated pedicled fasciocutaneous donor flap of the thickness needed is created on the anterior and anterior-medial surface of the same thigh. The donor flap is based on the previously transplanted radial forearm fascial free flap. This method provides recreation of wholesome periarticular soft tissues, eradication of the local infection, increase of range of motion in the knee joint and possibility to fulfill in the future perspective total knee arthroplasty as well as any other surgical operations.

The use of combined radial forearm cutaneous flap and radial forearm fascial flap with vascularised palmaris longus tendon for full thickness cheek reconstruction and simultaneous static lift of the oral commissure

The use of combined radial forearm cutaneous flap and radial forearm fascial flap with vascularised palmaris longus tendon for full thickness cheek reconstruction and simultaneous static lift of the oral commissure

Perforator-Based Radial Forearm Fascial Flap for Management of Recurrent Carpal Tunnel Syndrome

To study the benefit of using the perforator-based radial forearm fascial flap for patients with recurrent carpal tunnel syndrome. We used a perforator-based radial forearm fascial flap in 8 patients to cover the median nerve. All of the patients had undergone an index carpal tunnel release, and 3 of them had undergone at least 1 revision surgery to further decompress the median nerve. At average of 20 months (range, 6-30 mo) after the forearm fascial flap, all patients reported symptomatic improvement with complete resolution of nighttime symptoms. No patient reported worsening of symptoms; however, some subjective parasthesias persisted in 3 of the 8 patients. Objective assessment revealed complete resolution of a Tinel sign in 5 of 8 patients and noteworthy improvement in the remaining 3 patients. Average 2-point discrimination was 10.0 mm before surgery and 5.4 mm after surgery, average grip strength improved from 13.5 kg to 21.0 kg, and average tip pinch strength improved from 4.1 kg to 7.0 kg. The perforator-based radial forearm fascial flap may prove useful in the setting of recurrent carpal tunnel syndrome after surgical decompression. Therapeutic IV.

The use of a combined radial forearm flap and radial fascial flap for layered dural lining and an orbital defect reconstruction

Variable reconstruction methods for craniofacial tumour resections have been devised with the primary purpose to improve quality of life and disease control. The reconstructive aims are to provide a watertight seal, cranial base support while allowing a cosmetically pleasing result. For defects involving the orbit, maintenance of the depth of the orbital socket remains important for prosthetic fitting and a bulky flap is not advisable for this purpose. This case demonstrates the use of a combination pericranial flap, radial forearm fascial flap and cutaneous radial forearm flap. We have been able to achieve a watertight seal of dura in multiple layers, provide adequate support to the cranial base while giving a non bulky reconstruction of the orbit.

Perspectives on the Evolution of Rhinoplasty

Perspectives on the Evolution of Rhinoplasty

Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction

A free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome.

Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction

ABSTRACTA free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome.

Reverse Radial Forearm Fascial Flap with Radial Artery Preservation

The reverse radial forearm fascial (RRFF) flap is widely used in soft-tissue reconstruction of the hand. The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch. In patients with an abnormal Allen test because of an incomplete palmar arch, the traditional RRFF flap is contraindicated unless a vein graft is used to reconstruct the radial artery. A simpler alternative approach for hand reconstruction in such patients is a distally based RRFF flap based on radial artery perforators, which preserves the radial artery. We used RRFF flaps based on radial artery perforators in five patients who had palmar or dorsal soft-tissue loss. All five recovered full hand function, and only one had any complications (full-thickness skin graft loss at recipient site). The RRFF flap based on distal radial artery perforators is suitable for thin coverage of soft-tissue defects in hands with either a complete or an incomplete palmar arch.

Reconstruction of Hand Soft-Tissue Defects: Alternatives to the Radial Forearm Fasciocutaneous Flap

Soft-tissue defects of the hand and wrist are not an uncommon problem confronting the hand surgeon. Over the past 20 years the retrograde radial forearm fasciocutaneous flap has gained widespread acceptance in reconstruction of these defects. Appreciation of the inherent limitations of this workhorse flap and increased understanding of the blood supply of the upper extremity have prompted the development of several alternative pedicled forearm flaps. Aspects of surgical technique, specific limitations, and indications for the radial forearm fascial flap, the posterior interosseous artery flap, the retrograde radial artery perforator flap, and the dorsal ulnar artery flap are discussed and a reconstructive algorithm for flap selection is presented.

Management of an acquired tracheoesophageal fistula with a fascial free flap

Failure in the primary repair of a benign acquired tracheoesophageal fistula limits the operative options available at revision. Use of a fascial free flap to treat this condition has not been previously reported. We review the case of a patient who had a tracheoesophageal fistula develop after percutaneous tracheostomy, who had failed previous primary repair with strap muscle interposition. A radial forearm fascial free flap was used at revision and resulted in resolution of the fistula. Use of a fascial free flap to address a persistent acquired tracheoesophageal fistula, when an accompanying stenotic segment is not present, is a viable treatment option.

Progress in larynx-sparing surgery for glottic cancer through tracheal transplantation.

The current surgical treatment for unilateral, advanced glottic cancer is a total laryngectomy. Usually, the noninvolved hemilarynx needs resection because the resulting laryngeal defect cannot be reconstructed after adequate tumor resection. Experimental findings suggest that segments of autologous trachea may restore extended laryngeal defects. The authors used tracheal transplantation to save laryngeal function after the removal of advanced glottic cancer. In this case series review, 10 patients were treated during a 1.5-year period, with an average follow-up of 8 months. Evaluated factors included survival of the tracheal transplant and functional outcome with regard to the onset and quality of the airway, speech, and deglutition. The authors showed that segments of cervical trachea may restore extended laryngeal defects after initial revascularization by a radial forearm fascial flap. The fascial flap served as a vascular carrier for the transplanted trachea. Follow-up showed the stability of the reconstruction. Compared with a total laryngectomy, a striking improvement in patient comfort and function was noticed. Transplantation of the trachea is a technique that may save laryngeal function after the treatment of advanced-stage glottic cancer. These findings may improve laryngeal preservation strategies in treating laryngeal cancer.

Free flap reconstruction of the foot.

Free flap reconstruction of the foot has been widely performed in the last 20 years, but choice of a free transferred substitute for the soft tissue of the particular defect remains controversial. The authors present a series of 77 free flaps to the foot performed in 68 patients during October 1976 and September 1997. Long-term follow-up ranged from 12 months to 18 years (median, 44.4 months). Seventy-three flaps were transferred successfully (95%). The indications for a specific flap depended on the localization and extension of the foot defect. In weight-bearing areas the authors favored the use of a muscle flap covered with a split-thickness skin graft; the latissimus dorsi muscle was used primarily. This study shows a lower ulceration rate in muscle flaps covered with split-thickness skin grafts than in fasciocutaneous flaps in weight-bearing areas (27% vs. 60%). In nonweight-bearing areas, fasciocutaneous flaps were the best choice. In this series, the lateral arm flap was applied most often. The authors recommend free fascial flaps (serratus fascial flap or radial forearm fascial flap) covered by split- or full-thickness skin grafts for coverage of the malleolar region as well as coverage of exposed tendons of nonweight-bearing regions. Proper tailoring of the flap and postoperative care are very important to maintain a result without ulceration, as is avoiding having the suture line cross a weight-bearing area. Tactile sensation does not seem to be essential.

Total ear reconstruction in post burn deformity

Severe thermal injuries to the external ear, in most cases, lead to a total destruction of the pinna. Total ear reconstruction in such cases of burns is one of the most difficult problems faced by a plastic surgeon. This is because of the paucity and poor quality of the skin available in the auricular region. Depending upon the quality and quantity of skin available in the auricular region, patients with total loss of ear following burns were divided into five groups. The surgical procedure for ear reconstruction differed in each group due to differences in skin available for coverage of the cartilage framework. Different covering methods which were used for the draping of the cartilage framework were, normal post auricular skin, local grafted or scarred but soft and supple skin, post auricular fascia, temporoparietal fascia (pedicled or free) and free radial forearm fascial flap. A temporoparietal fascial flap was the cover of choice if local skin was not healthy. During the past eight years, seventy six cases of total ear reconstruction were done for post burn ear deformities. The technique and results are presented here.

The radial forearm fascial flap as a salvage procedure for chronic tuberculosis of the hand and wrist

A patient with tuberculous infection of the hand and wrist developed a recurrent draining wound of the right forearm. After recurrent failure of surgical debridement and wound closure under antituberculous therapy, wound closure was established by means of a radial forearm fascial flap with an excellent functional and cosmetic result. Extra-pulmonary tuberculosis must be kept in mind in the diagnosis of slowly growing tumours and chronic wounds in the upper extremity.

Tracheal autotransplantation: a reliable reconstructive technique for extended hemilaryngectomy defects.

Current surgical treatment for a glottic cancer with significant subglottic extension is a total laryngectomy. The objective of this study was to expand laryngeal conservation procedures by using a reconstructive technique that allows for the repair of hemicricolaryngectomy defects. After resection of the ipsilateral thyroid, cricoid, and arytenoid for advanced T3 glottic cancer, the laryngeal defect was reconstructed by means of an autotransplanted segment of trachea in four patients. The reconstruction consisted of a transferable patch that was constructed from a segment of revascularized cervical trachea. During a 14-day period, a 4-cm segment of cervical trachea was wrapped by a free radial forearm fascial flap. In the second stage, the glottic cancer was removed and the cervical trachea was isolated on its fascial blood supply and transformed into a patch that was used to repair the extended hemilaryngectomy defect. Two different patch designs were used. Two patients underwent reconstruction with a patch augmented at the glottic level (group A); two patients underwent reconstruction without glottic augmentation on the patch (group B). Tracheal continuity was restored by an end-to-end reanastomosis. The postreconstruction morphology of the two patch designs was compared with the preoperative laryngeal morphology. The autotransplantation technique led to complete restoration of the subglottic airway lumen in all four patients. Although the anterior-posterior glottic diameter was reduced by 36% in group A patients and by 43.5% in group B patients, a sufficient glottic airway lumen was obtained. The glottic sphincteric function was restored in both groups. Tracheal autotransplantation may be used reliably to repair hemicricolaryngectomy defects. Augmentation of the patch at the level of the glottis is not essential for successful rehabilitation.

PEDICLE FLAPS FOR COVERAGE OF THE WRIST AND HAND

The coverage of wounds about the hand and wrist may be accomplished by numerous pedicled flaps. Attention must be given to preservation of the perforating arteries that supply these fasciocutaneous flaps. Difficulties with wound healing over the area of flap harvest may occur and care must be given to preservation of the peritenon in the distal forearm. The use of fascial flaps may allow coverage that is quite pliable and the radial forearm fascial flap may be performed with preservation of the radial artery. In some cases, the use of a groin flap may be required for coverage of large wounds that do not have arteries available for sacrifice.

The retrograde radial fascial forearm flap: Surgical rationale, technique, and clinical application

The retrograde radial fascial forearm flap may be used to provide appropriate tissue coverage for nerve, tendon, or soft tissue defects in the forearm and hand. The procedure is differentiated from the standard radial forearm flap in that the radial artery remains intact when the retrograde radial fascial flap is designed. The rationale, technique, and clinical application of the flap are presented in order to allow surgeons to maintain the radial arterial trunk in continuity while obtaining the advantage of appropriate soft tissue cover in this critical area.