Osteocutaneous Radial Forearm Flap Research Articles

Oromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases.

One of the more difficult problems in reconstructive surgery of the head and neck is replacement of bone and soft tissue lost because of injury, osteomyelitis, or malignancy. The radial-forearm osteocutaneous flap is an accepted choice for oromandibular reconstruction. This study was undertaken to review one center's experience with 60 consecutive cases of oromandibular reconstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, flap failure rate, recipient- and donor-site complications, length of surgery, and hospital stay. Cancer resection was the reason for 97 percent of reconstructions; 33 percent of flaps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Mean skin flap size was 55 cm2 (range, 15 to 117 cm2) and mean bone length, 9.4 cm (range, 5 to 14 cm). The microvascular success rate was 98.3 percent. Complications included fracture of the donor radius (15 percent), nonunion of the mandible (5 percent), and hematoma (8.3 percent). These results are comparable to results reported in the literature with other radial forearm flaps. The free radial osteocutaneous flap is a safe and reliable choice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomosis to the contralateral side of the neck. The above attributes make the radial forearm osteocutaneous flap one of the "first line" flap choices for oromandibular reconstruction.

Oromandibular Reconstruction with the Radial-Forearm Osteocutaneous Flap: Experience with 60 Consecutive Cases

Thoma, Achilleas M.D., F.R.C.S.(C), F.A.C.S.; Khadaroo, Rachel B.Sc.; Grigenas, Orest M.D.; Archibald, Stuart M.D., F.R.C.S.(C); Jackson, Stanley M.D., F.R.C.S.(C); Young, J. E. M. M.D., F.R.C.S.(C), F.A.C.S.; Veltri, Karen M.Sc. Author Information

Prophylactic plating of the donor site of osteocutaneous radial forearm flaps

We carried out a retrospective study of fracture morbidity of radial forearm osteocutaneous donor sites. During a period of three-and-a-half years, 12 patients had had composite flaps taken, and 5 of them had subsequently fractured the radius. We then elected to plate the radius prophylactically and found that over a period of just over two years, none of the 8 patients who had had prophylactic plating at the original harvesting operation had subsequently fractured the radius.

Osteocutaneous radial forearm flap for hand reconstruction.

We treated 5 patients (4 men and 1 woman) with bone and soft tissue defects or total thumb loss using an osteocutaneous radial forearm flap. Their ages at the time of surgery ranged from 27 to 65 years (mean, 53 years). Preoperative conditions were traumatic loss of the thumb in 3 cases and severe injuries with soft tissue and bone defects in 2. The length of the donated radius ranged from 2 to 7 cm (mean, 4.7 cm). In 4 patients the radial forearm flap was transposed, including the lateral antebrachial cutaneous nerve as a sensory flap. Simultaneous iliac bone grafting to the donor site was also performed in 4 of the cases. The follow-up period ranged from 44 to 87 months (mean, 64 months). All flaps survived over their full extent. Radiographic bone union was attained after 2 to 3 months (mean, 2.5 months). Two-point discrimination over the 4 sensory flaps ranged from 8 to 15 mm (mean, 10.8 mm). No radius fractures occurred. No patients showed signs of vascular insufficiency from sacrifice of the radial artery. The radial forearm flap provides thin skin of good texture together with bone for a 1-stage reconstruction. For patients with skin and bone defects of the hand, a radial forearm osteocutaneous flap is recommended. This flap is also recommended for patients with traumatic thumb loss, if the dorsalis pedis artery is absent, or if the patient declines using tissue from the foot.

Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases

SUMMARY. From July 1994 to December 1996, 22 cases of primary female transsexualism received phalloplasty using free radial forearm osteocutaneous flaps in The Veterans General Hospital, Taipei, Taiwan. Follow-up period ranged from 6 months to 35 months. No complete flap loss and one partial loss (10% reduction) were noted after operation. The urethrocutaneous fistula rate was 40.9%, needing fistula repair surgery. Urethral stricture was noted in three cases (13.7%). Significant donor forearm morbidity was noted in two cases (9.1%) including one who suffered from radius bone fracture. All preserved ‘clitorises’ had intact erotic sensation and all neophalli gained protective sensation within 9 months. No ‘penile fracture’ was noted. In nine cases that have regular sexual activities, the sexual performance was rated as satisfactory. We share our experience and recommend that the free radial forearm osteocutaneous tubing flap is a promising choice for phalloplasty in female-to-male transsexuals.

Mandible reconstruction with the radial forearm flap

The radial forearm osteocutaneous flap is arguably the best flap for the restoration of intraoral function following oromandibular reconstruction: As well having ample surface area, its skin is thin, supple, capable of providing separate paddles for lining and cover, and most importantly, capable of reinnervation for sensate oral reconstruction. The donor site is remote from the recipient, allowing a two-team approach without respositioning. The vessels are large and the pedicle is long. The bone is strong but its usable length is short. It lacks vertical height as well as bulk. In low-volume resections the cosmetic results are excellent, but the cosmetic outcome is less satisfactory when bulky tissue has been resected. Bony defects exceeding 10 cm are probably unsuitable for reconstruction with this flap. Forearm skin may be hairy, and when much is taken, the donor site scar is a conspicuous cosmetic defect. Overzealous harvesting of bone, inadequate postoperative splintage, unusual forces, or sheer bad luck can result in a fractured radius. Yet the flap is reliable and the rates of bony union are high. Donor defects may be minimized by meticulous surgical technique, limiting the bone graft to one third of the distal radial circumference, direct wound closure when possible, and appropriate postoperative splintage. Fractures of the radius are rare under these circumstances. With the correct indications, the radial forearm flap has a distinct and unique role to play in reconstructing composite oromandibular defects.

Reconstruction of a defect in the median part of the thumb using an osteocutaneous radial forearm flap. (Polish)

Reconstruction of a defect in the median part of the thumb using an osteocutaneous radial forearm flap. (Polish)

The fate of the osteotomized free radial forearm osteocutaneous flap in mandible reconstruction.

The radial forearm osteocutaneous free flap has become a standard method of mandible reconstruction. In order to improve the contour of the reconstructed jaw in large resections, especially the anterior defect, the radial forearm bone graft needs to be osteotomized. The bone graft is nourished by small branches of the radial artery via the fascial connections between the skin flap and bone. The effect of the osteotomy, fixation devices, and the angulation of the bone segment on bone viability and eventual bone healing is not known. Forty-two radial forearm osteocutaneous flaps were used for composite mandible reconstruction. In 25 patients, the bone graft required osteotomy to achieve contour, of which 16 required single osteotomy and nine required double osteotomy. In a remaining 17 cases, no osteotomy was performed. Only those patients who had at least a 1-year follow-up were included in this study. The proportion of patients who achieved bone union was similar for both groups (i.e. osteotomy vs. nonosteotomy). Performing osteotomies on the segment of the radius in free osteocutaneous transfers is safe, and it allows for more flexibility in reconstruction, to achieve a natural-appearing jaw.

Fracture of the Radial Forearm Osteocutaneous Donor Site

Since the introduction of the osteocutaneous radial forearm flap in 1983, fractures of the radius have been reported to occur in approximately 30% of cases. Fracture of the donor forearm has been the cause of the most significant morbidity, and the difficulty in management of these fractures has been reported. We report our experience in managing three fractures involving the donor forearm. Optimum results can be achieved by early stabilization with external fixation and vascularized bone grafting. Excessive resection of the radius should be avoided and alternative sources of vascularized bone used to avoid mutilation of the forearm.

Oromandibular Reconstruction Using a Keel-shaped Modification of the Radial Forearm Osteocutaneous Flap

The keel-shaped modification for harvest of the radial forearm osteocutaneous flap has been used to reconstruct 19 oromandibular defects in 18 patients. Fourteen men and 4 women ranging in age from 22 to 72 years have undergone composite mandibular reconstruction, with follow-up ranging from 3 to 36 months. Sixteen patients (17 reconstructions) had resection of advanced malignancies, and 2 patients sustained shotgun wounds. Twelve symphyseal and 7 lateral or posterior defects were reconstructed with donor radius bone ranging in length from 5 to 13.5 cm. Double osteotomies were performed in 7 patients. Two skin paddles were used in 4 patients to provide simultaneous intraoral lining and external skin coverage. The radial forearm osteocutaneous flap is still an excellent choice for oromandibular reconstruction. Anterior and lateral composite mandibular defects were satisfactorily reconstructed both aesthetically and functionally using the keel-shaped modification of the radial forearm flap. Donor-site problems were uncommon and minor, and long-term forearm function was minimally affected. Radius fracture occurred in only 1 patient.

Results of one-stage penile reconstruction using an innervated radial osteocutaneous flap.

Reconstruction of the penis may be indicated in cases of traumatic or surgical amputation of the penis, congenital absence of the penis, micropenis, male pseudohermaphroditism, or transsexualism. Despite recent advances in microsurgery, which have improved the results of total penile reconstructions to a great extent, this operation remains one of the biggest challenges to reconstructive plastic surgeons. The authors have performed one-stage penile reconstruction in five patients since 1989, using an innervated radial forearm osteocutaneous flap. At follow-up (up to 46 months), all patients showed aesthetically acceptable results and good sensory recovery. The most common complications were related to the urethra, involving two fistulae and one urethral stricture.

Donor Site Deficit of the Osteocutaneous Radial Forearm Flap

A functional evaluation was made of osteocutaneous radial forearm flap donor upper extremities at a mean 19.4 months postoperatively. Donor deficits were evaluated as follows: (1) skin: subjective appearance and durability; (2) skeleton: range of motion of adjacent joints; (3) vessels: cold intolerance, digital temperature, digital--brachial index; (4) muscle: key pinch; (5) nerve: two-point discrimination of dorsal first web space. Ten consecutive patients with a mean donor site area of 51.5 cm2 and mean length of harvested radius of 10.9 cm were studied. Incomplete skin graft take at the donor site (7 of 10 patients) and appearance of fair or poor (6 of 10 patients) were frequent cutaneous complications. Wrist range of motion was decreased with pronation (90%), flexion (90%), and extension (89%). Mean digital temperature, comparing extremities that did (operated) and did not (nonoperated) undergo surgery, or comparing the radial artery-supplied fingers to the ulnar artery-supplied fingers within the same operated hand showed no effect from the lost radial artery. Mean digital-brachial index was 1.24 for the nonoperated and 1.15 for the operated extremity. Key pinch on the operated side was a mean of 74% of the nonoperated side. Although raising the flap creates multiple tissue deficits, each with the potential to alter upper extremity function, detailed functional evaluation failed to demonstrate significant alteration in upper extremity function after flap harvest.

One Stage Reconstruction of Intercalated Defect of the Thumb Using the Osteocutaneous Radial Forearm Flap

A radial forearm flap including a segment of the cortex of the radius, based on the distal pedicle of the radial vessels and the cephalic vein, was used to reconstruct an intercalated defect of the thumb in two cases. In one case it was used as an ipsilateral pedicle flap while in the other case it was used as a free microvascular flap. In both cases, the skin flap as well as the segment of bone survived in toto without any evidence of creeping substitution. The functional result was good in both cases. This flap provides thin skin of good texture together with bone for a one-stage reconstruction.

The Pronator Quadratus Muscle Flap

Skin-graft take following elevation of the osteocutaneous radial forearm flap has been shown to be difficult. The pronator quadratus muscle flap can be elevated to cover the exposed osteotomized radius and flexor carpi radialis and brachioradialis tendons. This technique is technically easy to perform and may significantly reduce donor-site wound-healing problems.

The Radial Forearm Flap

SummaryThe radial forearm osteocutaneous flap is recently described single stage method for reconstruction of the thumb. The long term results of the two cases treated by us are being presented. The value of the procedure under Indian conditions has been discussed.

The blood supply of the bone component of the compound osteocutaneous radial forearm flap—An anatomical study

The blood supply of the bone component of the compound osteocutaneous radial forearm flap—An anatomical study

One stage reconstruction of intercalated defect of the thumb using the osteocutaneous radial forearm flap

A radial forearm flap including a segment of the cortex of the radius, based on the distal pedicle of the radial vessels and the cephalic vein, was used to reconstruct an intercalated defect of the thumb in two cases. In one case it was used as an ipsilateral pedicle flap while in the other case it was used as a free microvascular flap. In both cases, the skin flap as well as the segment of bone survived in toto without any evidence of creeping substitution. The functional result was good in both cases. This flap provides thin skin of good texture together with bone for a one-stage reconstruction.

One-stage reconstruction of the thumb using an osteo-cutaneous radial artery forearm flap

One stage reconstruction of the thumb, with a satisfactory functional result, is described using an osteo-cutaneous radial artery forearm island flap.

The blood supply of the bone component of the compound osteo-cutaneous radial artery forearm flap—an anatomical study

This paper reports the results of an investigation into the blood supply of that portion of the distal radius which may be incorporated into the fasciocutaneous radial artery forearm flap. The findings demonstrate that when detached from its medullary blood supply, this segment of bone is supplied predominantly by two fascioperiosteal branches of the radial artery augmented by a musculoperiosteal plexus at the site of attachment of flexor pollicis longus.

The osteocutaneous pedicle forearm flap

Two patients treated by an osteocutaneous radial island flap with retrograde blood flow are described. Rotation of the flap and its distal vascular pedicle by nearly 180 degrees caused no impairment of the arterial flow, but it may interfere with the venous return through the radial veins, as observed in one of our cases. Therefore, it is safer to include in the skin flap an additional vein, suturing it to a superficial vein in the recipient zone, thus ensuring normal venous flow to the flap as well. The purpose of this paper is to present two patients treated by the use of an osteocutaneous radial artery forearm flap.