Free Radial Forearm Research Articles

The use of the radial styloid in the extended osteocutaneous radial forearm free flap.

The osteocutaneous radial forearm free flap (OC-RFFF) remains a useful tool in head and neck reconstruction; however, it can be challenging to harvest sufficient bone for large reconstructions. The extended OC-RFFF is a modification that involves harvest of the distal border of the radius to the tip of the styloid. This increases the length of the bone flap by 2 cm to 3 cm, and the inherent contour of the styloid can be used to reconstruct the anterior curvature of the mandible or maxilla without additional osteotomies that may reduce blood supply. The key steps in harvesting the extended OC-RFFF are described. Six patients with mandibular or maxillary defects underwent reconstruction with the extended OC-RFFF. Patient data including demographics, defect features, reconstruction details and outcomes were collected. Of the six patients who underwent the extended OC-RFFF, four had mandibular reconstruction and two had maxillary reconstruction. Two patients underwent reconstruction for osteoradionecrosis and the remainder for malignant disease. The average patient age at the time of surgery was 64.5 years. The length of radius harvested ranged from 8 cm to 14 cm (mean 9.7 cm). Two of six patients required a single osteotomy of their bone flap. Donor site complications included partial skin graft loss in 50% and a radius fracture in two patients. Recipient site complications included one patient with intraoral plate exposure. There have been no cases of nonunion. The extended OC-RFFF was a safe and reliable option for bony reconstruction in the head and neck.

Challenges in global microsurgery: A six year review of outcomes at an East African hospital

Free tissue transfer is an invaluable resource for reconstruction of complex defects. There is very little evidence as to the feasibility and outcomes of microsurgery performed in East Africa. This study will analyse outcomes of 114 consecutive free flaps, performed over 6 years at a single plastic surgery unit in Uganda. It aims to demonstrate that despite its challenges, successful microsurgical practice can be set up in East Africa. The notes of 100 consecutive patients who underwent 114 free flaps between 01/06/2009 and 01/07/2015 at CoRSU Hospital, Uganda were analysed. One hundred and fourteen free flaps were performed on 100 patients. The types of free flaps used included free fibula (n = 41), ALT (n = 30), gracillis (n = 8), radial forearm (n = 7), latissimus dorsi (n = 9) and rectus (n = 7) amongst others (n = 12). The most common indications for surgery were head and neck cancer (n = 50), trauma (n = 19), osteomyelitis (n = 18), burns (n = 13), head and neck infection (n = 6). Over the six year period there was an overall 76% survival of the flaps. However in the last two years of the series there was a flap survival rate of over 93% (n = 50). There were 40 non-microsurgical complications including wound infection (n = 10) and graft loss (n = 8). This is one of the first studies to report on the outcomes of free flaps performed at an East African centre. There is a steep but surmountable learning curve to improve microsurgery delivery in East Africa. This study identifies challenges in patient demographics, surgical experience and resources that have been overcome to improve outcomes.

Reliability of Free Radial Forearm Flap for Tongue Reconstruction Following Oncosurgical Resection

Introduction
 Primary closure following oncosurgical resection of carcinoma tongue has been found to compromise tongue function in regards to speech and swallowing very badly. In contrast, reconstruction of tongue with free radial forearm flap following oncosurgical resection has shown promising functional outcome.
 Materials and Methods
 Thirteen patients (ten male and three female) with squamous cell carcinoma involving anterior 2/3rd of tongue had undergone either hemiglossectomy or subtotal glossectomy. Reconstruction was done with free radial forearm flap following oncosurgical resection and neck dissection. All of them received postoperative radiotherapy. Follow-up ranged from 2 months to 2 years. The age of the patients ranged between 32 and 65 years. Flap dimension ranged from 7x6 cm to 10x8 cm. Vascular anastomosis performed in an end-to-end manner with 8-0 Ethilon® under loupe magnifiacation.
 Results
 Venous congestion occurred in one patient after 48 hours postoperatively and the flap underwent complete necrosis on postoperative day 5. Postoperative hematoma was found in one patient within first 24 hours of reconstruction. Re-exploration was done immediately, blood clots were removed. No fresh bleeding point was seen and the flap survived. In this series, 12 out of 13 flaps survived completely (92%).
 Conclusion
 The free radial forearm flap has become a workhorse flap in head and reconstruction due to its lack of extra bulk, relative ease of dissection, long vascular pedicle, good calibre vessels, malleability and minimal donor site morbidity. Furthermore its low flap loss and complication rate offer the best choice for tongue reconstruction.

Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects.

BackgroundTo compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap.Material and MethodsThe clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery.ResultsAmong these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05).ConclusionsThin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity. Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity.

Free Radial Forearm Flap in Head and Neck: Our Experience

IntroductionOncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. MethodsRetrospective study of procedures performed between 2006 and 2012. ResultsA total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<.05). ConclusionsReconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology.

Upper extremity morbidity after radial forearm flap harvest: a prospective study

To determine the effect of radial forearm free (RFF) flap harvest on patient-reported postoperative upper extremity disability. Patients undergoing RFF flap reconstruction following resection of head and neck cancer were recruited and matched with similar patients undergoing non-RFF reconstruction. All subjects completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire preoperatively and at least 1 year postoperatively. Postoperative DASH scores were significantly higher (more severe disability) in patients undergoing RFF flap reconstruction (6.93 ± 5.54; n = 52) compared with those undergoing non-RFF flap surgeries (2.95 ± 4.42; n = 52). Preoperative DASH score, flap size, patient age and tumour stage were significantly correlated with postoperative DASH score. Excluding the effect of neck dissection, RFF flap reconstruction has a significant deleterious effect on upper extremity function.

Comparison Studies of Different Flaps for Reconstruction of Buccal Defects

Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation.

Erratum to: Reconstructive management of the rare bilateral oral submucos fibrosisusing nasolabial flap in comparison with free radial forearm flap - a randomisedprospective trial

BackgroundOral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.MethodsThis study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.ResultsAverage increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value > 0.05.ConclusionsBased on the results of this study, there was no significant difference in mouth opening after reconstruction with radial forearm free flap compared to nasolabial flap.

Reliability of Venous Couplers for Microanastomosis of the Venae Comitantes in Free Radial Forearm Flaps for Head and Neck Reconstruction

The radial forearm free flap has gained popularity in head and neck reconstruction after oncologic resection because of its versatility. This popularity has only intensified with the advances in technique and instrumentation. Although debated in the past, the success of using the deep venae comitantes system for flap drainage is well documented. Although the use of couplers in a variety of flap anastomoses has been described in the literature, to our knowledge this is the first series presented on the use of couplers in small, deep system venae comitantes. We retrospectively examined our experience in 61 patients who underwent radial forearm free flaps for head and neck reconstruction. Of the 61 patients, 22 anastomoses were hand sewn, and 39 anastomoses were performed using venous couplers. No flap losses occurred in the group in whom venous couplers were used. In addition, no intraoperative thromboses, arterial or venous, were noted with coupler use. Our series demonstrates that the venous coupler is a safe and effective alternative to the hand-sewn anastomosis of the radial forearm free flap venous comitantes in head and neck reconstruction.

Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap - a randomised prospective trial

BackgroundOral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.MethodsThis study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.ResultsAverage increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value > 0.05.ConclusionBased on this study radial forearm free flap is a superior method compared to transposition of nasolabial flap to cover the surgical wound of oral submucous fibrosis.

Assessment of Quality of Life in Thirty-seven Cases of Tongue Cancer Defect Patients with Reconstructed with Radial Free Forearm Flap

Assessment of Quality of Life in Thirty-seven Cases of Tongue Cancer Defect Patients with Reconstructed with Radial Free Forearm Flap

Anterior Superficial Temporal Artery Island Flap

There are many options for the repair of intraoral defects. Today, free radial forearm or anterolateral thigh perforator flap is the first choice for the repair of intraoral defects. However, the importance of regional flaps is still maintained for patients whose medical condition is inappropriate for a long surgery and anesthesia time. In this report, we present our clinical experience with 9 patients who underwent retromolar trigone, buccal mucosal, gingival, and mouth floor reconstruction with anterior superficial temporal artery island flap (ASTIF) which has not been described in the literature before. Their mean age is 49 (27-85) years. ASTIF dimensions used for the reconstructions ranged from 3 × 5 to 8 × 16 cm. No partial or total flap necrosis was seen in any of the patients; only 3 patients had venous congestion problem for the first 3 days of the surgery, but they all healed well. Five patients had squamous cell carcinoma, 2 patients had squamous cell carcinoma with local recurrence, 1 patient had adenocarcinoma, and 1 patient had mandibular osteocarcinoma. Patients were followed for a minimum of 6 months postoperatively (average 12 months, range 6 to 24 months). ASTIF provides an excellent alternative for reconstructing defects of the oral cavity for some patients who have significant comorbid conditions or specific contraindications to free tissue transfer. At the same time, the combination with the free flaps increases the success of the restoration. Level IV therapeutic study.

Reconstruction of Total Nasal Defect Including Skin, Bone, and Lining, Using a Single Free Radial Forearm Osteocutaneous Perforator Flap

Reconstruction of Total Nasal Defect Including Skin, Bone, and Lining, Using a Single Free Radial Forearm Osteocutaneous Perforator Flap

Free Radial Forearm Fasciocutaneous Flap in the Treatment of Distal Third Tibial Osteomyelitis

Osteomyelitis of the lower limb, associated with soft-tissue defects, is a reconstructive challenge. Microvascular free-tissue reconstruction is an important surgical option with the superiority of free muscle and myocutaneous flaps being explored by various publications. Muscle flaps provide good quality vascularized tissue which can be contoured into defects, but their bulk can often lead to the reconstruction having a suboptimal aesthetic outcome. This result is usually most evident in the lower third of the tibia. We present our series of free radial forearm fasciocutaneous flaps for reconstruction of distal third tibial soft-tissue defects following debridement of osteomyelitic foci and bony stabilization. A retrospective case-note review of 20 patients treated with free radial forearm fasciocutaneous flap reconstruction of distal third tibial soft-tissue defects following excision of osteomyelitis and adjacent scar tissue, and bony stabilization between January 1999 and December 2006 was conducted. There were 20 patients who had established osteomyelitis of the distal third of tibia following previous open fractures. The mean size of the soft-tissue defect at the time of the free fasciocutaneous flap procedure was 72.3 cm(2) and the mean bony defect was 3.4 cm. The mean duration of the procedure was 417 minutes and flap ischemia time did not extend beyond 60 minutes in any of the cases. Overall flap survival was 100% and all patients had radiologic bony union at a mean of 5.73 months. The average period of follow-up was 22.5 (range, 19-36) months, and none of the patients had a recurrence of the disease during the follow-up period. Free fasciocutaneous flap reconstruction for soft-tissue defects of the lower limb in our series was seen to be safe, reliable, and provided an aesthetic outcome with high patient satisfaction rates. We advocate the use of free fasciocutaneous flaps for small-to-moderate sized defects of the distal third of the tibia after debridement for chronic osteomyelitis. Although we have used radial forearm flaps in our series, more modern free fasciocutaneous flaps with less donor-site morbidity may be preferred.

Microvascular Tissue Transfer in Cleft Palate Patients

The closure of wide palatal clefts and recurrent oronasal fistulae may be challenging. After repeated failure of conventional techniques, microvascular tissue transfer may be indicated in the closure of such fistulae. Depending on the location and the size of the palatal fistula, different tissues are required to sufficiently close the palatal gaps. A subdivision of common flaps into mucosa, muscular, bony, skin, and fascia flaps was carried out to analyze their suitability for alveolar, hard, and soft palate reconstruction. Furthermore, the bulk of flaps and the length of the vascular pedicle were analyzed to rate the suitability of different flaps for palatal closure. Based on a new classification of oronasal fistulae, all these factors were taken into consideration to introduce a decision guidance of what microvascular flap fits a particular clinical situation. The radial free forearm flap was found to be sufficient in the closure of all classes of oronasal fistulae.

赤唇伸展皮弁と遊離前腕皮弁による頬部, 口角, 口唇の一期的再建法

赤唇伸展皮弁と遊離前腕皮弁による頬部, 口角, 口唇の一期的再建法

Reconstruction of Buccal Mucosa, Upper and Lower Lip Defect Using Free Radial Forearm Flap with Palmaris Longus Tendon: A Case Presentation

Introduction: Advanced lip carcinomas can invade adjacent structures. Performing surgery for these cancers will lead to defects in this anatomically and functionally important area and will cause post-op difficulties such as drooling, speech alterations and aesthetic considerations, if not properly managed. Case Report: In this study, we will introduce a radial forearm free flap with palmaris longus tendon to reconstruct a defect of a large lower lip carcinoma. Our patients was a male in the 7 th decade of life with an advanced lower lip carcinoma invading the full thickness of the buccal mucosa, left commissure and the left third of the upper lip. Resection was performed with adequate margins; checked by frozen sections and radical modified neck dissection was also performed on the left side. Free radial forearm flap with palmaris longus tendon was harvested and anastomosed in the neck. Four months after surgery commissurroplasty was done and the flap volume reduced Conclusion: The radial forearm free flap with palmaris longus tendon provides a good functional lip with a reasonable aesthetics in our patient. The patient was satisfied with the result and there were no functional complaints such as drooling reported by him. We think that this flap could be a flap of choice for reconstruction of the large, full thickness lip defects.

Radial forearm flap donor site morbidity following V-Y skin graft closure

Introduction: The radial free forearm fasciocutaneous flap is a reliable and versatile replacement in the reconstruction of intra oral soft tissue defects. Potential donor site complications have lead to a variety of techniques to minimise donor site morbidity. The aim of our study is to retrospectively analyse and quantify donor site morbidity and compare our experience with available literature.

Sensibility following Innervated Free Radial Forearm Flap for Penile Reconstruction

The free radial forearm flap has proven to be reliable for penile reconstruction. The purpose of this study was to determine whether neurotization of this flap improved sensation of the reconstructed penis. A long-term follow-up study of 45 patients undergoing penile reconstruction using free radial forearm flap was performed; 28 of the 45 patients received an innervated flap, and 17 received a noninnervated flap. A nerve repair between the dorsal nerve of the penis and the lateral antebrachial cutaneous nerve was performed for innervation. Sensory testing, including pain perception, temperature perception, vibratory threshold, and static two-point discrimination, was performed by one blinded examiner in a standardized pattern. Mean follow-up time was 9.1 years. Mean patient age was 26.4 years (range, 18 to 48 years). Postoperative pain perception and vibratory threshold were similar between the two groups in the proximal part of the neophallus but were significantly better in the innervated flaps (p < 0.01) in the distal part. Noninnervated flaps displayed a pattern of increasing sensibility from the distal part toward the proximal part, whereas innervated flaps regained sensation throughout. The innervated group had a better result of temperature perception and static two-point discrimination in both the proximal and the distal parts. Innervation of free radial forearm flap provides improved sensation to the reconstructed penis. If it is possible to find the functional recipient nerve, innervation should always be conducted.

Intraoperative Hemodynamic Evaluation of the Radial and Ulnar Arteries during Free Radial Forearm Flap Procedure

The purpose of this prospective study was to assess the blood flow of the radial and ulnar arteries before and after radial forearm flap raising. Twenty-two patients underwent radial forearm microvascular reconstruction for leg soft tissue defects. Blood flow of the radial, ulnar, and recipient arteries was measured intraoperatively by transit-time and ultrasonic flowmeter. In the in situ radial artery, the mean blood flow was 60.5 +/- 47.7 mL/min before, 6.7 +/- 4.1 mL/min after raising the flap, and 5.8 +/- 2.0 mL/min after end-to-end anastomosis to the recipient artery. In the ulnar artery, the mean blood flow was 60.5 +/- 43.3 mL/min before harvesting the radial forearm flap and significantly increased to 85.7 +/- 57.9 mL/min after radial artery sacrifice. A significant difference was also found between this value and the value of blood flow in the ulnar and radial arteries pooled together ( P < 0.05). The vascular resistance in the ulnar artery decreased significantly after the radial artery flap raising (from 2.7 +/- 3.1 to 1.9 +/- 2.2 peripheral resistance units, P = 0.010). The forearm has a conspicuous arterial vascularization not only through the radial and ulnar arteries but also through the interosseous system. The raising of the radial forearm flap increases blood flow and decreases vascular resistance in the ulnar artery.