Reconstruction of the radial forearm free flap donor site with an acellular dermal regenerative matrix “Integra” on Fitzpatrick Type 1 skin

AbstractObjectiveEvaluation of post-operative donor site disability remains unaddressed in radial forearm free flap cases. This study aimed to assess donor site dysfunction following radial forearm free flap harvest using validated general, disease-specific and site-specific disability questionnaires.MethodsIn this retrospective case series of 24 patients at a tertiary academic medical centre, patients were assessed using the Short Form 36 Health Survey, Short Musculoskeletal Function Assessment questionnaire, and Disabilities of the Arm, Shoulder and Hand questionnaire. One-sample z-tests were performed, comparing means of the cohort to controls.ResultsCompared to population controls, the cohort had higher mean scores for the Disabilities of the Arm, Shoulder and Hand questionnaire (18.22 vs 10.1, p < 0.01), and Short Musculoskeletal Function Assessment questionnaire bothersome index (21.44 vs 13.77, p = 0.04), and a lower mean score for the Short Form 36 Health Survey physical component (38.88 vs 50, p < 0.01), indicating a greater disability for the cohort compared to controls.ConclusionRadial forearm free flap harvest causes significant long-term donor site disability in head and neck tumour patients. The Disabilities of the Arm, Shoulder and Hand questionnaire is a concise tool for measuring this dysfunction.

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Donor-Site Morbidity of the Radial Forearm Free Flap after 125 Phalloplasties in Gender Identity Disorder

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000221110.43002.a0 ◽

2006 ◽

Vol 118 (5) ◽

pp. 1171-1177 ◽

Cited By ~ 45

Author(s):

Gennaro Selvaggi ◽

Stan Monstrey ◽

Piet Hoebeke ◽

Peter Ceulemans ◽

Koen Van Landuyt ◽

...

Keyword(s):

Gender Identity ◽

Free Flap ◽

Gender Identity Disorder ◽

Donor Site ◽

Donor Site Morbidity ◽

Radial Forearm Free Flap ◽

Radial Forearm

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Management of the Radial Forearm Free Flap Donor Site With the Vacuum-Assisted Closure (VAC) System

The Laryngoscope ◽

10.1097/01.mlg.0000235935.07261.98 ◽

2006 ◽

Vol 116 (10) ◽

pp. 1918-1922 ◽

Cited By ~ 34

Author(s):

Brian T. Andrews ◽

Russell B. Smith ◽

Kristi E. Chang ◽

Joseph Scharpf ◽

David P. Goldstein ◽

...

Keyword(s):

Free Flap ◽

Donor Site ◽

Radial Forearm Free Flap ◽

Vacuum Assisted Closure ◽

Radial Forearm

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Suprafascial Harvest of the Radial Forearm Free Flap Decreases the Risk of Postoperative Tendon Exposure

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489416685322 ◽

2017 ◽

Vol 126 (3) ◽

pp. 224-228 ◽

Cited By ~ 7

Author(s):

David C. Shonka ◽

Nikita V. Kohli ◽

Benjamin M. Milam ◽

Mark J. Jameson

Keyword(s):

Free Flap ◽

Donor Site ◽

Retrospective Chart Review ◽

Split Thickness Skin Graft ◽

Radial Forearm Free Flap ◽

Tourniquet Time ◽

Exact Test ◽

Harvest Technique ◽

Thickness Skin ◽

Radial Forearm

Objective: To determine if suprafascial harvest of the radial forearm free flap improves postoperative donor site outcomes compared to subfascial harvest. Methods: Retrospective chart review. Results: Forty-six patients underwent reconstruction of a head and neck defect with a radial forearm free flap (RFFF). Subfascial harvest of the RFFF was performed in 25 (53%) patients and suprafascial harvest performed in 22 (47%) patients. All donor sites were covered with a split thickness skin graft and a bolster that remained in place for 6 days. Postoperative tendon exposure at the donor site occurred in 5 (20%) of the patients in the subfascial group and in 0 (0%) of the patients in the suprafascial group ( P = .05; Fisher’s exact test). Average tourniquet time was 117 minutes in the subfascial group and 102 minutes in the suprafascial group. Hematoma formation occurred at the donor site in 2 (8%) and 1 (5%) patients in the subfascial and suprafascial groups, respectively. There were no complete or partial flap losses in either group. Conclusions: Suprafascial harvest of the RFFF decreases the risk of postoperative tendon exposure. The suprafascial harvest technique does not increase harvest time or donor site complications, nor does it negatively impact flap vascularity.

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Re: Vander Lei et al. Closure of radial Forearm Free Flap donor site with local full-thickness skin graft

British Journal of Oral and Maxillofacial Surgery ◽

10.1054/bjom.1999.0215 ◽

2000 ◽

Vol 38 (4) ◽

pp. 402

Author(s):

David A. Mitchell

Keyword(s):

Skin Graft ◽

Free Flap ◽

Donor Site ◽

Radial Forearm Free Flap ◽

Full Thickness ◽

Full Thickness Skin Graft ◽

Full Thickness Skin ◽

Thickness Skin ◽

Radial Forearm

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Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature

Folia Medica ◽

10.2478/v10153-011-0090-x ◽

2012 ◽

Vol 54 (2) ◽

pp. 60-65 ◽

Cited By ~ 2

Author(s):

Dimitar D. Pazardzhikliev ◽

Christo D. Shipkov ◽

Ilya P. Yovchev ◽

Regina H. Khater ◽

Ivailo S. Kamishev

Keyword(s):

Case Report ◽

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Functional Results ◽

Donor Site Morbidity ◽

Oral Feeding ◽

Tram Flap ◽

Radial Forearm Free Flap ◽

Radial Forearm

ABSTRACT Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free flap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48- year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free flap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as “excellent” and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable flap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator flap, RFFF, anterolateral thigh and ulnar forearm flap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM flap, latissimus dorsi myocutaneous free flap, pectoralis major musculocutaneous flap and trapezius island flap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

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