Forearm Free Flap Research Articles

Quality of life in patients after reconstruction with the supraclavicular artery island flap (SCAIF) versus the radial free forearm flap (RFFF).

Gold-standard for defect reconstruction in the head and neck region is the radial free forearm flap (RFFF). The supraclavicular artery island flap (SCAIF) gained popularity due to its versatility. Our objective was to compare functional advantages between both modalities. A retrospective analysis of 24 consecutive cases with advanced-stage squamous cell cancer of the oral cavity and oropharynx after cancer defect reconstruction with two modalities (12 SCAIF; 12 RFFF) was conducted. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, Quality of Life Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (QLQ-H&N35). Mean follow-up was 22.2±9.5months. Comparison of quality of life (QOL) showed significant differences only in speech and problems with the senses in favor of the SCAIF. Patients report satisfactory QOL results after oncologic surgery and reconstruction with preliminary no significant differences in most aspects comparing the two modalities. Therefore, the SCAIF appears as a viable alternative to the gold standard, the RFFF.

Free iliac musculocutaneous flap combined with free forearm flap to repair complex oral cancer defects: a case report

四川省肿瘤医院收治1例硬软组织复合型缺损的晚期口腔癌患者，运用显微外科技术结合计算机辅助设计及3D打印技术，采用游离髂骨肌皮瓣联合游离前臂皮瓣修复复杂性缺损并达到满意的修复效果。.

Effect of size difference between hemiglossectomy and reconstruction flap on oral functions: A retrospective cohort study

Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios. This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal-Wallis test, and Scheffe test were used in statistical analyses. Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59-2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3-1.8, and ≥1.8. Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.

Outcome of patients with failed pelvic fracture-associated urethral injury repair: A single centre 10-year experience.

The management of recurrent posterior urethral strictures developing after pelvic fracture urethral injury (PFUI) is a challenging task. Despite availability of many surgical approaches, there is no consensus regarding the optimal approach. The objective of this study was to present our 10-year experience in the management of recurrent urethral strictures due to PFUI. We did a retrospective single-institution review of patients who underwent surgical management for recurrent posterior urethral strictures from January 2006 to December 2016 using descriptive statistics. We included only those patients with PFUI who underwent some definitive surgical procedure for their previous failed repair(s). The final analysis included data of 50 male patients (10 adolescents and 40 adults). Mean age of the patients was 29.92±10.62 years. The average length of stricture was 3.02±1.47 cm. Progressive perineal urethroplasty (PPU) was done in 40 cases. Two patients with concomitant rectourethral fistula/false passage underwent transpubic urethroplasty (TPU). Three patients with complete bulbar necrosis were managed with single stage/staged preputial tube reconstruction. One patient underwent microsurgical urethroplasty using radial free forearm flap while in two patients each Mitrofanoff appendicovesicostomy and perineal urethrostomy was done. Majority of complications were minor (Clavien Grade 1 and 2). Overall success rate of PPU was 75%. Mean follow-up period was 29.46±10.68 months (range: 13-60 months). Most cases of recurrent posterior urethral strictures of <3 cm in length can be operated by PPU with reasonable success rates. Complex and long-segment (higher than 3 cm) strictures require use of ancillary procedures like TPU, substitution urethroplasty and Mitrofanoff appendicovescostomy.

Aesthetic and Functional Evaluation of Large Full-Thickness Vermilion and Lower Lip Defects Reconstruction.

It is hardly to reconstruct a huge defect of lower lip by using of partial flap which brings no mouth closing functional problem. In this study, we would like to introduce our experience in large full-thickness vermilion and lower lip/chin defects reconstruction, and also focus on the evaluation of the surgery effects. The large lower lip and chin (include vermilion) reconstruction were performed in Sichuan Provincial People's Hospital (2012-2015). The surgery experience was introduced in this study first. In the following section, after a statement of these basic problems, various situations involving are investigated, such as the surgical effects of aesthetic and function that were evaluated through a visual analogue scale (VAS) by doctors and patients separately. The VAS score assessments of 2 kinds of surgery were collected and compared. A total of 7 patients use the tongue flap alone. Four patients use the combination of the free forearm flap and the anterior ventral tongue flap (COMBO flap). The VAS score of doctors group was significantly lower than the patients group (P < 0.05), and the aesthetic appearance was excellent (>90 points). Language features were not affected (>90 points). Slight mouth opening problems exist on these patients who were used COMBO flaps (>80 points; <90 points). The drooling and drumming gas problems were not observed. These 11 patients had no recurrence within 12 months after the operation. The 1:1 ratio between upper and lower lip is crucial to the design of anterior ventral tongue flap which brings with an excellent 3-dimensional morphologic and anatomic structure outcome. The bite block might become an essential operation step for vermilion reconstruction by using of tongue flap. And the COMBO flap may enhance the facial aesthetics and oral function for the reconstruction.

Reconstruction of scarring pharyngeal stenosis with forearm free flap:a case report

A 33-year-old man presented with recurrent oral ulcers for more than 10 years,accompanying dyspnea and dysphagia for 1 year and aggravate for 1 month.Physical examination:pharyngeal cavity stenosis,mucous retention, epiglottis was extruded into the infant type. Electronic laryngoscope:Epiglottis curl,bilateral pyriform sinus disappeared.Ulcer and scar changes can be seen in the lateral wall of bilateral hypopharynx, piriform sinus and posterior annular area,and cover the throat inlet.Neck CT showed: soft tissue thickening in the posterior wall of oropharynx and laryngopharynx-prevertebral fascia, thickening in the right aryepiglottic fold and with local niche;slight uneven enhancement in enhanced scanning, and disappearance of bilateral pyriform sinus.Bilateral parapharyngeal space is clear, laryngopharyngeal wall is not thick, bilateral vocal cords are not thick, and laryngopharyngeal space is clear.Diagnosis: pharyngeal stenosis (scar?); Behcet's disease..

Management of the total glossectomy defect with latissimus dorsi free flap

Radical surgical management of tongue cancer results in sever speech and swallowing disruption, impaired airway protection and life-threatening aspiration. Surgical objective of total glossectomy defect management is an adequate restoration of lingual mass and affected tissues of the floor of the mouth. Range of flaps are known to provide the adequate outcome, i. e. pediculed pectoralis major flap, anterolateral free thigh flap, rectus abdominis flap, radial free forearm flap and latissimus dorsi flap. In the current report, we present a case of glossectomy defect reconstruction with pediculed latissimus dorsi flap. Postoperative assessment of the transplant was made according to clinical criteria and viability of the flap was assessed via laser Doppler flowmetry. Signs of microcirculation improved starting from day 5 postoperatively, and were almost equal with donor site microcirculation signs on day 14. A sufficiently large mass of the transplant allowed to create a thickening over the epiglottis, as well as to close the defect in the oral cavity. The latissimus dorsi flap in the tongue reconstruction has a high potential: its use provides a relatively good quality of articulation, recovery of deglutition.

Somatosensory changes at forearm donor sites following three different surgical flap techniques

BackgroundThe aim of this study was to investigate the somatosensory changes at the forearm donor region after using different types of modified flap surgical techniques. MethodsThirty-one patients, who underwent oral and maxillofacial reconstructive surgery involving the use of a traditional radial forearm flap (TRFF) or two modified radial forearm flap techniques (MRFF-I; MRFF-II), participated in the study. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), pressure pain threshold (PPT), mechanical detection threshold (MDT), and mechanical pain threshold (MPT) were assessed at four sites of the forearms corresponding to the middle of the vascular pedicle (VP) area, the middle of the forearm flap area, and the corresponding contralateral sites (cVP and cFF) at about 5.0 ± 1.9 months after the surgery. Data were analysed with one-way ANOVA, and post-hoc tests were performed using Tukey's Honest Significant Difference test. ResultsSignificant differences between the VP and cVP sites were detected for WDT (P < 0.001) in TRFF and for WDT (P < 0.001) and MDT (P = 0.006) in MRFF-I. Significant differences among TRFF, MRFF-I, and MRFF-II at the VP site were detected for CDT (P = 0.022), WDT (P < 0.001), and MDT (P = 0.015). MRFF-II was associated with significantly higher sensitivity compared to that of TRFF for WDT (P = 0.017) and higher sensitivity compared to that of MRFF-I for CDT (P = 0.017), WDT (P < 0.001), and MDT (P = 0.013). ConclusionsSignificant sensory loss was detected for all types of surgical procedures with free forearm flaps. However, the MRFF-II was associated with a better sensory recovery at short follow-up after surgery. These results suggest that a longer follow-up period and larger sample size should be included in future studies.

Retrospective study of survival in human papillomavirus-negative oropharyngeal squamous cell carcinoma treated with primary surgery and associated prognostic factors.

BackgroundOropharyngeal squamous cell carcinoma (OPSCC) is an aggressive malignancy which has been investigated for decades and reported highly associated with the human papillomavirus (HPV) infection, yet there is no consensus reached on the optimal treatment paradigm. The relatively lower prevalence of HPV in China makes it important to evaluate the outcomes of HPV-negative OPSCC.PurposeOur study was carried out in an attempt to evaluate the outcomes of squamous cell carcinoma of the oropharynx treated with primary surgery and identify the associated prognostic factors.Patients and methodsWe retrospectively analyzed the outcomes of the primary surgically treated HPV-negative OPSCC cases at our institution between 2008 and 2013. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were determined by Kaplan–Meier analysis. Prognostic factors of outcomes were investigated by uni- and multivariate analyses.ResultsIn this study, neck metastasis rate was 61.3%. Level II nodes were the most vulnerable. The 3-year disease-specific survival, overall survival, and disease-free survival rates were 76.7%, 75.6%, and 62.8%, respectively. Forearm free flaps were the most commonly utilized in the reconstructions. A multivariate analysis indicated that N stage and adjuvant radiotherapy were predictive factors for 3-year disease-specific survival.ConclusionThe outcomes of the surgical treatment of oropharyngeal squamous cell carcinoma were acceptable, and N-stage, adjuvant radiotherapy were identified as prognostic factors.

Blood bridge venous flap to repair finger wound with proper palmar digital artery defect

Objective To explore the application and clinical effect of blood bridge venous flap in finger wound with proper palmar digital artery defect. Methods From February, 2007 to September, 2016, 11 cases of fin- ger wound with artery defect were repaired with forearm vein free flap by the way of bridging blood vessels. The time from injury to surgery was 1.5 to 6 hours (average 2.5 hours) . Vascular defect length was 1.4 to 3.4 cm (average 2.3 cm) . 8 cases were bridged the unilateral digital artery and 3 cases were bridged the both side. The area of skin flap was 1.5 cm × 2.0 cm to 2.2 cm × 3.5 cm and the donor site was sutured directly. Results One case appeared necrosis in marginal part and healed after dressing change. The other flaps and finger survived and the incisions healed well.All the 11 cases were followed up after operation. The follow-up time ranged from 6 to 20 months, aver- aged 10 months. The color and texture were well ,the sensation of temperature, pain and tactile were recovered, and the flap had good contour. According to TAM system evaluation method: 6 cases got excellent results, 4 cases were good, 1 case was poor. The donor site only had a linear scar and the flexion and extension of wrist were not limited. Conclusion Flow bridging venous flap can reconstruct the finger blood and repair the wound simultaneously. To the finger with nerve or tendon defect, bridged with the cutaneous nerve or palmaris longus tendon can also get satisfactory result. Key words: Surgical flap; Venous flap; Finger injuries; Proper palmar digital artery; Microsurgical operation

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators &amp;amp; Its Clinical Applications in Head &amp;amp; Neck Reconstruction

Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.15%) & were not clinically significant. 104 perforators were greater than 0.5 mm in diameter (46.84%) & were clinically significant. 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators, on radial side was 10.6 & 7.9 on ulnar side; comparison of both using student t paired test gives a P value of 0.006, which is significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0; Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean diameter of perforators on Distal side (1.11) & Proximal side (0.86), side using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which was more than 1 mm (80%) & less than 1 mm (20%) & on proximal side more than 1 mm (35.6%) & less than 1 mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1 & P value of <0.001 was achieved which was found to be highly significant. Methylene blue injections demonstrated clusters both in proximal & distal forearm & also marked the cutaneous territory of flap. Three-dimensional computed tomographic angiography reveals a network of linking vessels found to communicate between adjacent perforators & running parallel to radial artery. A total of 15 patients were reconstructed with shape modified radial forearm flap following oncologic resections. Wound healing in all 15 patients was good, with scar assessment faring better than traditional radial forearm flap. There was no sensory or motor nerve deficit. Although pedicle length was comparatively shorter in shape-modified flap, there was no problem in anastomosing to neck vessels. Conclusion: Increase in knowledge of vascular territory of radial artery perforators with regards to numbers, size, location, & cutaneous territory can lead to expanded use of radial forearm flap based on either distal or proximal perforator alone. Shape modified technique for harvesting radial forearm flap allows primary closure of donor site. Donor site is better healed and shows a predicted pattern, which is functionally and aesthetically good.

The anatomy of forearm free flap phalloplasty for transgender surgery.

Transgender surgeries are becoming more frequent and visual interpretation of anatomy is essential for both surgeons and patients. Since the forearm free flap phalloplasty was introduced in 1984, it has been known to provide reliable cosmetic and functional results for transitioning men compared with phalloplasty by different flaps. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. The forearm free flap consists of the anterior forearm skin, subcutaneous tissue, fascia containing the radial artery as the perforator and its venae comitantes, cephalic and basilic veins, and lateral and medial antebrachial cutaneous nerves are demonstrated in relation to the surgically derived flap. Song's forearm free flap phalloplasty requires two surgical stages with a three-month interval between the stages: prelamination of a neourethra and construction of a neophallus. The neophallus created by forearm flap phalloplasty is reported to achieve acceptable aesthetical and psychological satisfaction, appropriate size and shape, and satisfying sexual intercourse. Despite increasing experiences in gender confirming surgery with modifications made by many authors, urethral complications including fistula and/or stricture formation are the leading causes of reoperation. The poor esthetic outcome of the forearm donor site and a decrease in rigidity of the neophallus are the main limitations. Illustrations of anatomy help inform surgical choice and understanding of risks and benefits by patients. The anatomy of the free forearm flap phalloplasty supports creation of a neophallus for transsexual anatomy revision. Clin. Anat. 31:145-151, 2018. © 2017 Wiley Periodicals, Inc.

Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall

Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan-Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi2 test were also calculated. 23 patients were included (mean age of 62years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.

A Retrospective Volume Matched Analysis of the Submental Artery Island Pedicled Flap as Compared to the Forearm Free Flap: Is It a Good Alternative Choice for the Reconstruction of Defects of the Oral Cavity and Oropharynx?

The submental artery island pedicled flap (SMIF) is an underused alternative for reconstruction of head and neck defects after tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients who underwent reconstruction with the SMIF versus the forearm free flap (FFF). A retrospective cohort study of all patients with oral cavity and oropharyngeal defects reconstructed with the SMIF and a cohort of patients with similar volume defects reconstructed with the FFF were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by analysis of variance and Fisher exact test. Average age was 61.8years in the SMIF group versus 57.9years in the FFF group. The most common defect was located in the tongue, with squamous cell carcinoma being the most common pathology identified. Flap volumes were similar (SMIF, 38.79cm3; FFF, 39.77cm3). Significant comparative outcomes identified with SMIF versus FFF reconstruction included shorter anesthesia times (815 vs 1,209minutes; P<.001), shorter operative times (653 vs 1,031minutes; P<.001), and less blood loss (223 vs 398mL; P=.04). Postoperative Eastern Co-operative Oncology Group performance score increased more for the FFF than for the SMIF group (+0.33 vs+1.25; P=.0019). Recipient site complication rates were lower for the FFF group (0.17 vs 0.42 per patient) but were not statistically relevant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5months. This is the first study to compare the SMIF with the FFF for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option compared with the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay, and donor site morbidity.

Primary reconstructive method for tracheal defect from invasion by differentiated thyroid carcinoma

Differentiated thyroid carcinoma is not highly malignant, and thus surgical resection is the most common treatment even if the carcinoma has invaded the trachea. Although some cases exist in which the carcinoma invades the trachea, using the tracheal window resection method allows complete resection of the carcinoma. Yet these patients must often control a large tracheocutaneous wound until reconstructive surgery is performed because such surgery occurs secondarily. Our hospital admitted three patients for which tracheally invasive, differentiated thyroid carcinoma was surgically resected. Tracheal defects of 1/2 to 2/3 of the tracheal circumference were reconstructed primarily using the free forearm flap and costal cartilage during carcinoma resection. Following surgery, only a small tracheocutaneous fistula remained open, which was closed at about three months post-operation. The reconstructed tracheal space and transferred costal cartilage thickness were monitored by CT scan imaging at about 12 months post-operation. Details of the reconstructive method and postoperative changes in the reconstructed trachea and thickness of the costal cartilage are described in this report.

The Rapid Development of Squamous Cell Carcinoma on the Nasal Dorsum of a Patient Receiving Immunosuppressive Therapy.

The risk of cancer is significantly increased in patients undergoing renal transplant surgery than in the general population. In particular, skin cancer is the most commonly occurring cancer in these patients.A 34-year-old man underwent living renal transplantation for focal segmental glomerulosclerosis. After 18 months, he developed a lesion on the nasal dorsum, approximately 1 cm in size, and the lesion rapidly expanded to cover the entire dorsum.Owing to its rapid expansion, the lesion was suspected to be a malignant tumor and wide excision was planned.We removed the lesion with a 6-mm margin. Squamous cell carcinoma was diagnosed through intraoperative rapid pathological examination. The nasal bone and septum were invaded by the tumor and, as a result, the entire external nose was removed. The patient's nose was subsequently reconstructed using a free forearm flap for lining, iliac bone graft for the nasal frame, and a scalping forehead flap for skin coverage.Selective target radiotherapy was administered at the closest margin around the lesion, and the dosage of immunosuppressants was reduced.At >2 years postoperatively, the patient showed good cosmetic results with no relapse or metastasis of the tumor.We report the unusual case of a young man who developed a rapidly progressing squamous cell carcinoma on his nasal dorsum after 18 months of immunosuppression. Squamous cell carcinoma in organ transplant recipients may be more aggressive and may progress differently than in regular patients. Therefore, special attention is required for patients who take immunosuppressive drugs after renal transplant surgery.

Phalloplastie : options microchirurgicales et algorithme décisionnel

The free radial forearm flap is considered as the gold standard in penile reconstruction for good functional and aesthetic results. The scar on donor site could be considered as pathognomonic of their situation by transsexual patients. The development of microsurgical flaps provides new therapeutic options. This options are discussed and a therapeutic algorithm is presented. The main techniques used are the pedicled anterolateral thigh perforator flap and free muscle sparing latissimus dorsi flap. Principal criteria are listed, the choice of patient and the local anatomical conditions are the most important. Antebrachial flap stay the first choice. In case of non-feasibility of this flap, phalloplasty with pedicle ALT flap or free MSLD flap will be proposed. Urethral reconstruction will be done by a narrow free forearm flap or by a delayed thin skin graft or buccal mucosa graft. Microsurgical phalloplasty options are not limited to the forearm flap. Satisfactory results can be obtained using alternative procedure. The use of a therapeutic algorithm allows to choose the most optimal solution for each patient.

A Case of Cerebrospinal Fluid Leakage Repair with Forearm Free Flap after Craniofacial Resection of Sinonasal Undifferentiated Carcinoma

A Case of Cerebrospinal Fluid Leakage Repair with Forearm Free Flap after Craniofacial Resection of Sinonasal Undifferentiated Carcinoma

Cephalic Vein-Pedicled Radial Forearm Semi-free Flap: An Alternative When no Suitable Vein in Recipient Site for Free Forearm Flap.

The risk of venous thrombosis is the main factor of free forearm flap necrosis. In some cases there is no suitable vein at recipient site to provide venous return of the free flap. In this report, two cephalic vein-pedicled radial forearm semi-free flaps were used as an alternative to resurface soft tissue defects in submaxilla and anterior cervical area. The two flaps survived uneventfully. The cephalic vein-pedicled radial forearm semi-free flap could be harvested with a long cephalic vein pedicle, and could be an alternative when there was no suitable or healthy recipient veins at recipient site.

Quality of Life Outcomes in Patients after Partial Glossectomy for T1-T3 Squamous Cell Carcinoma and Reconstruction With Either Primary Closure or Radial Free Forearm Flap

Quality of Life Outcomes in Patients after Partial Glossectomy for T1-T3 Squamous Cell Carcinoma and Reconstruction With Either Primary Closure or Radial Free Forearm Flap