Radial Forearm Fasciocutaneous Free Flap Research Articles

"Racing-stripe" Modification of Radial Forearm Free Flap: Technique and Experience (704 Consecutive Cases).

Retrospective chart review was conducted of a single surgeon's (E.G.M.) experience of patients who underwent RS-RFFF. Seven hundred four RS-RFFFs were performed in 698 patients over a 19-year period (2000-2019) for lower extremity reconstruction (657 flaps, 93.3%), upper extremity reconstruction (32 flaps, 4.5%), and head and neck reconstruction (15 flaps, 2.1%). Wounds secondary to trauma were the most common reason for flap reconstruction (655 wounds, 93.8%). Five hundred four RS-RFFFs were used for soft-tissue defects of the foot (129 flaps, 18.3%), ankle (309 flaps, 43.9%), and heel (66 flaps, 9.4%; 27 of which provided coverage for Achilles tendon repair or exposure). There were three flap losses (0.4%). Limb salvage rate was 100% for extremity wounds. Forearm donor site wound complications were minimal. The RS-RFFF can be consistently and safely harvested and permits low-profile, reliable coverage of small-to-medium size soft-tissue defects. Primary closure of the donor site is possible in all cases, thus minimizing wound healing complications.

International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma

Background: Several reports have suggested that radiotherapy after reconstructive surgery for head and neck cancer (HNC), could have deleterious effects on the flaps with respect to functional outcomes. To predict and prevent toxicities, flap delineation should be accurate and reproducible. The objective of the present study was to evaluate the interobserver variability of frequent types of flaps used in HNC, based on the recent GORTEC atlas. Materials and methods: Each member of an international working group (WG) consisting of 14 experts delineated the flaps on a CT set from six patients. Each patient had one of the five most commonly used flaps in HNC: a regional pedicled pectoralis major myocutaneous flap, a local pedicled rotational soft tissue facial artery musculo-mucosal (FAMM) (2 patients), a fasciocutaneous radial forearm free flap, a soft tissue anterolateral thigh (ALT) free flap, or a fibular free flap. The WG’s contours were compared to a reference contour, validated by a surgeon and a radiologist specializing in HNC. Contours were considered as reproducible if the median Dice Similarity Coefficient (DSC) was > 0.7. Results: The median volumes of the six flaps delineated by the WG were close to the reference contour value, with approximately 50 cc for the pectoral, fibula, and ALT flaps, 20 cc for the radial forearm, and up to 10 cc for the FAMM. The volumetric ratio was thus close to the optimal value of 100% for all flaps. The median DSC obtained by the WG compared to the reference for the pectoralis flap, the FAMM, the radial forearm flap, ALT flap, and the fibular flap were 0.82, 0.40, 0.76, 0.81, and 0.76, respectively. Conclusions: This study showed that the delineation of four main flaps used for HNC was reproducible. The delineation of the FAMM, however, requires close cooperation between radiologist, surgeon and radiation oncologist because of the poor visibility of this flap on CT and its small size.

Tracheoesophageal fistula and pharyngoesophageal stenosis repair by double skin paddle radial forearm flap

Tracheoesophageal fistula (TEF) constitutes a rare, but serious complication in laryngectomized patients, usually occurring after radiotherapy. TEF may occur spontaneously or may be due to enlargement of the TEF created for placement of a voice prosthesis. Surgical treatment of TEF can be complex, especially in the presence of a concomitant pharyngoesophageal stenosis (PES), and is associated with a high failure rate. In this article, we describe the surgical reconstruction technique for TEF associated with PES using a double skin paddle fasciocutaneous radial forearm free flap. The key points of this technique consist of correct positioning of the 2 skin paddles in order to reconstruct the anterior pharyngoesophageal wall and posterior tracheal wall, as well as de-epidermization of the intermediate part of the flap, which is then placed in the tracheoesophageal space.

Free Tissue Transfer for Repair of Chronic Esophageal Perforations.

ObjectiveAnterior cervical discectomy and fusion have become a common intervention for cervical spine stabilization. However, complications can cause life-threatening morbidity. Among them, esophageal perforation is associated with severe morbidity, including dysphagia, malnutrition, and infection with the potential development of mediastinitis. Presentation is variable but often results in chronic morbidity. Herein we examine our experiences in the management of esophageal perforation with microvascular free tissue transfer.Study DesignRetrospective review from January 2013 to September 2020.SettingSingle academic tertiary care center.MethodsThis study comprised all patients (age, 41-73 years) undergoing free tissue transfer for the repair of chronic esophageal perforation secondary to anterior cervical discectomy and fusion at an academic tertiary care center. Four patients underwent repair via vastus lateralis myofascial onlay grafting for defects ≤2 cm in greatest dimension, while 1 patient underwent a fasciocutaneous radial forearm free flap repair of an 11 × 5–cm defect.ResultsDefect location ranged from hypopharynx to cervical esophagus. Mean operative time was 6.2 hours; the average length of stay for all patients was 6.6 days. Of 5 patients, 1 required additional hardware placement for spine stabilization. All patients underwent gastrostomy tube placement to bypass the surgical site during healing, and all eventually resumed an oral diet postoperatively. Recurrent fistula occurred in 1 of 5 patients. No flap failures were encountered in the study population.ConclusionVastus lateralis myofascial onlay grafting and fasciocutaneous radial forearm free flap are robust, relatively low-morbidity interventions with a high success rate for definitive repair of chronic esophageal perforation. Repair should be undertaken in concert with a spine surgeon for management of the cervical spine.

Midfacial Degloving Technique for Free Flap Reconstruction of Nasal and Anterior Skull Base Defects.

Traditionally, surgical access for extirpation and reconstruction of midfacial tumors requires external incisions that can cause a myriad of complications, especially in irradiated patients. The modern midfacial degloving approach involves hidden, sublabial and intranasal incisions that provide reliable access for free flap reconstruction of nasal and maxillofacial tumors. Seven patients with a history of radiation therapy underwent free flap reconstruction of the midface. Five patients underwent the technique in a delayed manner, and the remaining two underwent reconstruction immediately at the time of resection. Five patients underwent free radial forearm fasciocutaneous free flaps and two underwent reconstruction with anterolateral thigh perforator flaps. Bone and/or rib cartilage grafting was used in all patients. All patients underwent successful free flap reconstruction of the midface without external incisions. The most common complication was postoperative infection requiring oral or intravenous antibiotics. No patients sustained loss of their grafts or hardware in the postoperative period. The midfacial degloving technique provides satisfactory exposure to the nasal cavity, midface, orbits, and skull base for free flap reconstruction, without disrupting the external soft tissue. The authors describe a novel use of the midfacial degloving technique to provide safe and reliable results with improved cosmetic outcome.

Complications and loss of free flaps after reconstructions for oral cancer

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005–2010. The patients’ clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n=86, 45%) and the anterolateral thigh free flap (ALTFF) (n=48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n=25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41–50 years (p=0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p=0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.

Modification of fasciocutaneous radial forearm free flap to achieve two-layer closure during reconstruction of circumferential hypopharyngeal defects

Circumferential defects of the hypopharynx are a reconstructive challenge. Various local, regional and free flaps have been described with each having advantages and disadvantages in terms of functional outcomes. The fasciocutaneous radial forearm free flap (RFFF) is one of the most common free flaps used for reconstructing circumferential hypopharyngeal defects. The skin paddle is pliable and reasonably matches the native hypopharyngeal wall. It is easy to raise, has predictable vascular anatomy and a long pedicle. Unlike the anterior lateral thigh (ALT) flap, the RFFF is associated with higher rates of pharyngo-cutaneous fistula. This was thought to be due to the difficulty in achieving two-layer closure. However, in a post treatment neck or in patient with large body habitus, the use of ALT or other free flaps may not be possible leaving the RFFF as the only viable option. To aim to reduce the risk of fistula and wound dehiscence, we describe a novel design of RFFF, which provides two-layer closure. We believe that our design gives the reconstructive surgeon another reconstructive option, which should be considered in challenging circumferential hypopharyngeal defects.

Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap.

Background This study sought to characterize the donor-site complications associated with the osteocutaneous radial forearm free flap (ORFFF) used for mandibular reconstruction, as well as to compare donor-site complications between the ORFFF and fasciocutaneous radial forearm free flap (FRFFF). Methods An Institution Review Board approved, retrospective review identified all ORFFF and FRFFF performed for head and neck reconstruction with a single otolaryngology surgeon at an academic medical center over a 3-year period. Patients requiring an ORFFF underwent harvest of half of the diaphyseal diameter of the radius with prophylactic plating performed by hand surgeons. Donor-site outcomes including infection, skin graft loss, tendon exposure, neuropathy, radius fracture, hardware complications, and need for additional donor-site surgery were compared. Results In this study, 25 patients underwent ORFFF harvest, and 52 underwent FRFFF harvest. There was one radius fracture occurring in association with a hardware infection requiring reoperation. No fractures or other major donor-site complications were seen in the FRFFF group. Similar rates of minor complications were noted with skin graft take less than 50% in 4% (n = 1) and 8% (n = 4) with ORFFF and FRFFF, respectively, and tendon exposure in 8% (n = 2) and 15% (n = 8) with ORFFF and FRFFF, respectively. No soft tissue infections or sensory neuropathies were seen. Mean follow-up was 14.2 months for the ORFFF group and 11.7 months for the FRFFF group. Conclusion The risk of fracture following ORFFF harvest with prophylactic plating is small. Other donor-site complication rates were similar with both flap techniques.

Oral Cancer Reconstruction Using the Supraclavicular Artery Island Flap: Comparison to Free Radial Forearm Flap

To evaluate whether the pedicled supraclavicular artery island flap (SCAIF) is a sufficient alternative to the fasciocutaneous radial forearm free flap (RFFF) for oral reconstruction in cancer surgery. The authors designed and implemented a retrospective cohort study composed of all consecutive patients who underwent head and neck reconstruction after cancer surgery at their tertiary university hospital from 2013 to 2016. Demographics and peri- and postoperative information were recorded and statistically analyzed. Of 83 patients who underwent head and neck reconstruction after cancer, 50 were identified as having stage III or IV squamous cell carcinoma of the oral cavity and oropharynx and underwent surgery and reconstruction with the SCAIF (n=25) or the RFFF (n=25). Total surgery time (411.0 vs 576.4minutes; P<.001), flap elevation time (39.00 vs 93.78minutes; P<.001), need for intensive care observation (32 vs 96%; P<.05), and rate of tracheotomy (64 vs 88%; P<.05) were significantly lower in the SCAIF group. There was no statistical difference in the postoperative complication rate or postoperative functional swallowing ability between the 2 groups. Total perioperative costs were significantly lower in patients who underwent reconstruction with the SCAIF (2,621.15 vs 4,453.77€; P<.01). The results of this study suggest that the SCAIF is a straightforward and reliable flap with shorter operative times and comparable outcomes compared with the RFFF.

A non-randomized retrospective observational study on the subcutaneous esophageal reconstruction after esophagectomy: is it feasible in high-risk patients?

Esophageal reconstruction after esophagectomy is a complex procedure with high morbidity and mortality. Anastomotic leakage is more severe and frequent in patients with preoperative comorbidities and may present with septic conditions. Considering the possibility of an easier management of such cases, we evaluated the safety and feasibility of subcutaneous esophageal reconstruction in patients with high operative risks. We performed a non-randomized retrospective observational study on the 75 (subcutaneous: 21, intrathoracic: 54) esophageal cancer patients who underwent esophageal reconstruction either through subcutaneous or intrathoracic route between January 2003 and February 2015. Preoperative data including the estimated reasons for the selection of the subcutaneous route were obtained from medical charts. Clinical outcomes were evaluated and compared between the two groups. The mean postoperative hospital stay was longer in the subcutaneous group than the overall group. Anastomotic leakage occurred more frequently in the subcutaneous group [10 (47.6%) vs. 7 (13%), P=0.004]. Three major leakages resulted in chronic cutaneous fistula, but were successfully treated by lower neck reconstruction using radial forearm fasciocutaneous free flap (RFFF). There was no in-hospital mortality in the subcutaneous group. Subcutaneous esophageal reconstruction in high-risk patients showed a higher rate of anastomotic leakage. However, easier correction without fatal septic conditions could be obtained by primary repair or flap reconstruction resulting in lower perioperative mortality. Therefore, esophageal reconstruction through the subcutaneous route is not recommended as a routine primary option. However, in highly selected patients with unfavorable preoperative comorbidities or intraoperative findings, especially those with poor blood supply to the graft, graft hematoma or edema, or gross tumor invasion to surrounding tissues, esophageal reconstruction through the subcutaneous route may carefully be considered as an alternative to the conventional surgical techniques.

Donor Site Outcomes with Osteocutaneous versus Fasciocutaneous Radial Forearm Free Flap Harvest: Level 3 Evidence

There is no financial information to disclose. The osteocutaneous radial forearm free flap (ORFFF) has become an increasingly utilized reconstructive tool, particularly when the morbidity of other donor sites - such as the iliac crest or fibula - are less desirable. While initially associated with high donor site morbidity - especially radius fractures - increased experience and prophylactic plating have decreased these risks. This study hypothesized that the rates of donor site complications in patients undergoing ORFFF harvest with prophylactic plating with a diaphyseal-metaphyseal plate would be similar to those seen with fasciocutaneous radial forearm free flap harvest (FRFFF harvest). A retrospective review was performed for all patients who underwent osteocutaneous or fasciocutaneous radial forearm free flap harvest with a single otolaryngology surgeon over a 3-year period. Patients requiring an osteocutaneous flap underwent harvest of half of the diaphyseal diameter of the radius with prophylactic plating performed by an orthopaedic upper extremity surgeon. A 3.5/2.4mm diaphyseal-metaphyseal, volar distal radius, locking compression plate was used (Synthes. Paoli, PA, USA). Donor site outcomes including infection, skin graft loss, tendon exposure, neuropathy, fracture, hardware complications and donor site re-operation were compared between the groups. Two-tailed, Fischer’s exact test was used for data analysis. Twenty-five patients underwent ORFFF harvest and 53 patients underwent FRFFF harvest. An average of 7.5cm of radius was harvested in the ORFFF group with only 1 radius fracture, occurring in association with a hardware infection which required hardware removal and re-plating of the radius. No fractures were reported in the FRFFF group. No other major donor site complications requiring re-operation were seen in either group. Similar rates of minor complications were seen with skin graft take less than 50% in 4% (n = 1) and 7% (n = 4) with ORFFF and FRFFF, respectively, and tendon exposure in 8% (n = 2) and 15% (n = 8) with ORFFF and FRFFF, respectively. No soft tissue infections or superficial radial sensory neuropathies were seen. Mean follow-up was 14.2 months for the ORFFF group and 11.7 months for the FRFFF group. •The risk of fracture following osteocutaneous radial forearm free flap (ORFFF) harvest with this prophylactic plating technique is small, making it a safe donor site when an osteocutenous flap is needed for reconstruction.•Donor site complications including skin graft loss, tendon exposure, soft tissue infection and superficial radial sensory neuropathy occurred at similar rates among patients undergoing osteocutaneous and fasciocutaneous flap harvest.

Short‐term donor site morbidity: A comparison of the anterolateral thigh and radial forearm fasciocutaneous free flaps

Donor site morbidity is an important consideration in the overall decision-making algorithm for fasciocutaneous free flap reconstruction of the head and neck. A retrospective case series was conducted of donor site complications occurring within 30 days of surgery among 226 consecutive anterolateral thigh (ALT) or radial forearm free flap (RFFF) microvascular free tissue transfers performed by multiple reconstructive surgeons between 2005 and 2010. A greater number of donor site complications occurred among patients undergoing RFFF versus ALT free flaps (40; 35.4%; vs 14; 12.4%; p < .001). Wound dehiscence occurred significantly more frequently among patients undergoing RFFF versus ALT free flap reconstruction (34; 30%; vs 6; 5%; p < .001). Tendon exposure occurred in 16 of the 113 RFFFs (14.1%). Seromas occurred more commonly in the ALT group (6; 5%; vs 2; 1.7%; p = .280). Although short-term donor site morbidity was low in both groups, the ALT was associated with a significantly lower incidence of wound dehiscence with or without tendon exposure. © 2015 Wiley Periodicals, Inc. Head Neck 38: E945-E948, 2016.

Application of the radial forearm free flap for closure of very large nasoseptal perforations

Successful closure of very large (greater than 3 cm) nasal septal perforations is a formidable and technically challenging surgical task. This is largely attributed to volume restricted confines of the nasal cavity, and the availability and dependability of residual mucosal tissue for repair. This article details the microvascular free tissue transfer option, using a radial forearm fasciocutaneous free flap, and describes the functional recovery in two patients on which it was used.

PP004: The need for temporary palatal obturator for total palatal reconstruction with radial forearm free flap

Confident reconstruction of palatal defect by radial forearm fasciocutaneous free flap. A 67 year male patient who had total palate defect including hard palate after the ablative surgery of adenoid cystic carcinoma originating from soft palate were immediately reconstructed using radial forearm fasciocutaneous free flap to restore nasal and oral separation. Vascular anastomoses were done with facial vessels in neck and the donor site was closed with split thickness skin graft. All suture wounds in the oral and nasal side had healed primarily without complication till the postoperative 14th day. But the disruption of wounds and downward prolapsed of flap was noticed in the oral cavity during the follow-up session and it required revisional operation. During the revisional operation, a prefabricated temporal palatal obturator for the protection of the repair wounds and the anti-gravitational support was applied beneath the flap. After applying palatal obturator, no more disruption was reported in the additional follow-ups. The patient was then able to swallow soluble foods in the 3 weeks postoperatively and prepare the further radiation therapy. The temporary palatal obturator was safely removed 6 weeks after revisional operation. Radial forearm fasciocutaneous free flap is versatile for soft tissue reconstruction of palate which provides a satisfactory separation between oral and nasal cavity. But it can be prolapsed down due to gravity and its bulk and this makes disruption of the wound during early postoperative period. The temporary palatal obturator was a good answer to sustain the flap in place until secure implantation.

“You reap what you sow”—a case of heterotopic ossification within a fasciocutaneous radial forearm free flap reconstruction

Heterotopic ossification is the formation of new bone outside of the skeleton. We describe a previously unreported case of heterotopic ossification occurring within a fasciocutaneous radial forearm free flap for reconstruction following tongue squamous cell carcinoma resection. Although this is a benign condition, it is important to consider and exclude a neoplastic recurrence.

Closure of tracheoesophageal fistula with two‐layer tracheal‐esophagoplasty and tracheal advancement

Closure of tracheoesophageal fistula with two‐layer tracheal‐esophagoplasty and tracheal advancement

The Radial Forearm Fasciocutaneous Free Flap for Head and Neck Reconstruction

Sir:FigureFree tissue transfer is a mainstay in head and neck reconstruction following surgical oncologic tumor resection. Perhaps one of the most versatile free flaps that exists for head and neck reconstruction is the radial forearm fasciocutaneous flap, which allows for a thin, pliable piece of tissue to be transferred on a long vascular pedicle with a reliable blood supply.1,2 The reasons for this versatility lie in the aforementioned features, specifically, a long vascular pedicle that allows anastomosis to be performed outside of the zone of resection that may involve irradiated tissues. After obtaining institutional review board approval, a retrospective review of all cases of radial forearm fasciocutaneous free flaps for reconstruction of oncologic head and neck defects performed by the senior author (R.O.D.) between 2001 and 2010 was conducted. The retrospective review returned 55 patients. Of this, 15 (27 percent) were women and 40 (73 percent) were men. The average age of the patients was 58 years (range, 31 to 80 years). The average size of the oncologic defect was 63.1 cm2 (range, 30 to 120 cm2). In total, there were three flap failures (5.5 percent). There were 25 other complications noted in addition to the flap failures. There were 12 complications related to the recipient site other than flap failures. Of the 55 patients, 23 (42 percent) underwent preoperative radiation therapy. A two-sample t test revealed no relationship between the size of the defect and whether or not there was a complication of any nature (p = 0.32) or a complication at the recipient site (p = 0.23). A relationship approaching significance was noted between preoperative radiation therapy and complications at the recipient site (p = 0.052) (Fig. 1).Fig. 1: Comparison of complication rates between those with and without preoperative radiation therapy.The management of oral and airway malignancies is controversial, with radiation therapy and surgery being the favored options. In general, lower grade malignancies are regarded as better treated through radiation therapy alone, whereas higher grade malignancies are treated with surgery. This paradigm presents a problem when surgery is indicated following either failed radiation therapy or recurrent disease after radiation therapy. The competency of the vasculature in the region of the defect is often of concern following radiation therapy. Free flaps to the head and neck have been shown to be adversely affected by radiation therapy.3 Interestingly, in our review, there was no relationship found between preoperative radiation and the occurrence of complications. This may be explained by the extremely long pedicle that is possible with the radial forearm flap that provides the opportunity to bring the site of anastomosis for both the vein and artery away from the field of preoperative radiation and oncologic resection. In general, the vessels outside of this area are likely to be healthier and more suitable for microvascular anastomosis. This is especially important given that this patient population tends to be advanced in age and may suffer from concomitant peripheral vascular disease. Varying degrees of atherosclerosis were noted in each patient in this series. The radial forearm fasciocutaneous free flap remains a reliable and relatively easy flap to use for reconstruction of head and neck oncologic defects. Preoperative radiation therapy does not appear to affect the rate of complications following reconstruction with this flap. The flap's long pedicle allows for the site of anastomosis to be placed outside the area of tissue damage. Ian C. Hoppe, B.A. Priti P. Patel, M.D. Ramazi O. Datiashvili, M.D. Department of Surgery, Division of Plastic Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, N.J. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Apocrine Hidrocystoma Masquerading as a Posttraumatic Cerebrospinal Fluid Leak&lt;subtitle&gt;Case Report and Literature Review&lt;/subtitle&gt;

Otolaryngologists frequently care for patients with injuries that violate multiple aspects of the facial skeleton and skull base. Cerebrospinal fluid (CSF) leak is a common complication after skull base trauma. Two percent of head injuries and 12% to 30% of all basilar skull fractures result in CSF leak. 1 In a retrospective review 2 of 820 fractured temporal bones, 122 CSF fistulae were noted. Posttraumatic CSF leaks originate most commonly from frontal or ethmoid sinus fractures or appear after longitudinal temporal bone fracture. 3 Typically,CSFleakpresentsasclearnasaldrainageormeningitis.Wedescribeacaseofswelling in the midface under a radial forearm fasciocutaneous free flap that was used to reconstruct the palate, midface, and skull base. Initial evaluation of this painless, slow induration 1 year after enucleation of orbital remnants was highly suspicious for a skull base CSF leak, mucocele, or encephalocele. Surgical exploration and final pathologic analysis revealed an unusual presentation of a dermatologic entity: apocrine hidrocystoma.

Safe Osteocutaneous Radial Forearm Flap Harvest with Prophylactic Internal Fixation

We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest by the University of Kansas Head and Neck Microvascular Reconstruction Team. Mean follow-up was 13 months. One of two patients undergoing OCRFFF harvest without prophylactic fixation developed a pathological radius fracture. The 68 subsequent OCRFFF patients underwent prophylactic fixation of the donor radius, and none developed a symptomatic radius fracture. Five of 68 patients did have a radiographically visible fracture requiring no intervention. The plate fixation technique was further modified to exclude monocortical screws in the radius bone donor defect (subsequent 39 patients), without any further fractures detected. One patient required forearm hardware removal for an attritional extensor tendon tear. The described modified OCRFFF harvest and prophylactic plate fixation technique may eliminate postoperative pathological fracture of the donor radius. Donor morbidity is similar to that of the fasciocutaneous radial forearm free flap , affording safe use of OCRFFF in head and neck reconstruction.

Voie d’abord transorale et cervicale sans mandibulotomie dans les cancers de l’oropharynx avec réparation par lambeau libre fasciocutané antébrachial

Objective To evaluate the role of a combined transoral and cervical approach without mandibulotomy for surgery of oropharyngeal cancer with fasciocutaneous radial forearm free flap reconstruction. Material and methods All patients who underwent this type of surgery between 2003 and 2007 were included in this retrospective study. We analyzed postoperative outcomes, surgical margins (histological study) and the oncological and functional results. Results A total of 24 patients were included in this study. There was no free flap failure. Surgical margins were negative for 23 of the 24 patients. At 3 years, overall, cause-specific, and disease-free survival rates were 73, 76 and 68%, respectively. A good functional result (normal or slightly impaired function) was obtained for oral diet, speech, mouth opening and esthetic outcome in 78, 82, 92 and 86% of the patients, respectively. Conclusion This double surgical approach without mandibulotomy in selective cases can replace the transmandibular approach in locally advanced oropharyngeal cancer surgery.