S154 – Primary TEP and Patch Free-Flap Laryngectomy Reconstruction

Objectives 1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction. Methods Patients undergoing reconstruction with patch free-flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist. Results 77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87). Conclusions Primary TEP performed at the time of free-flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.

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Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i2.18242 ◽

2014 ◽

Vol 3 (2) ◽

pp. 33-37

Author(s):

Debashis Biswas ◽

Md Abul Kalam ◽

Tanveer Ahmed ◽

Md Rabiul Karim Khan

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Free Flaps ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Tissue Defect ◽

Radial Forearm ◽

After Cancer ◽

Microvascular Free Flap ◽

Tissue Defects

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

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Versatility of radial forearm free flap for intraoral reconstruction

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1506256j ◽

2015 ◽

Vol 143 (5-6) ◽

pp. 256-260 ◽

Cited By ~ 11

Author(s):

Jelena Jeremic ◽

Zivorad Nikolic

Keyword(s):

Free Flap ◽

Donor Site ◽

Free Flaps ◽

Radial Forearm Free Flap ◽

Sphincter Reconstruction ◽

Vein Thrombosis ◽

Single Donor ◽

Radial Forearm ◽

Acceptable Method ◽

Palmaris Longus Tendon

Introduction. The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. Objective. The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. Methods. This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5%) or delayed (2 patients, 9.5%) reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases), buccal mucosa (5 cases), lip (1 case) and a retromolar triangle (2 cases) defects, or after hemiglossectomy (7 cases). In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. Results. An overall success rate was 90.5%. Flap failures were detected in two (9.5%) patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis. The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. Conclusion. The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies.

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Microsurgical free tissue transfer as avaluable reconstructive procedure in foot reconstruction

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699192 ◽

2007 ◽

Vol 40 (02) ◽

pp. 141-146

Author(s):

mohamed el-shazly ◽

mohamed makboul

Keyword(s):

Free Flap ◽

Motor Vehicle ◽

Donor Site ◽

Free Tissue Transfer ◽

Free Flaps ◽

Vehicle Accidents ◽

Tissue Transfer ◽

Scapular Flap ◽

Radial Forearm ◽

Foot Reconstruction

ABSTRACT Background: owing to the limited soft tissue donor sites in the foot area, the use of microsurgical tissue transfer is frequently becoming mandatory in this area, especially in cases of massive defects due to the common motor vehicle accidents in the territory of upper egypt. free flaps offer a great variety of available tissues to cover larger, multifocal or multistructural defects. they also improve the perfusion of the infected poorly perfused areas.Objectives: in this study, we tried to evaluate foot defects according to their size, shape and site and to determine the general and specific parameters of free tissue transfer to the foot area in concomitance with the patients needs.Materials and methods: eleven patients were included in this study. for each patient, complete history was taken, general and local examination, photographic documentation, laboratory investigations, imaging and other investigations were performed. free flap transfers were applied in all cases as follows: latissimus dorsi flap in five cases, rectus abdominis flap in three cases, scapular flap in one case, gracilis flap in one case and radial forearm flap in one case.Results: nine flaps survived. no infection or donor site complications were recorded. every patient had the optimum free flap as regards the defect size, site, depth, condition, shape, donor site availability and the recipient vessels′ condition.Conclusion: the study of the optimum free flap for foot reconstruction in relation to the defect present and patient conditions is crucial to have significant results.

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Reconstruction of Oromandibular Defects by Vascularized Free Flaps: The Radial Forearm Free Flap and Fibular Free Flap as Major Donor Sites

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1314 ◽

2017 ◽

Vol 8 (3) ◽

pp. 98-101

Author(s):

Virani J Shamsuddin ◽

Sanjeev Patni ◽

Shashikant Saini ◽

Kamal K Lakhera ◽

Gurdyal S Kalra

Keyword(s):

Free Flap ◽

Free Flaps ◽

Radial Forearm Free Flap ◽

Radial Forearm ◽

Fibular Free Flap ◽

Major Donor

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Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction

Case Reports in Medicine ◽

10.1155/2014/458286 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Theodoros Stathas ◽

Georgios Tsinias ◽

Dimitra Tsiliboti ◽

Aris Tsiros ◽

Nicholas Mastronikolis ◽

...

Keyword(s):

Free Flap ◽

Free Flaps ◽

Radial Forearm Flap ◽

Lower Lip ◽

Lip Reconstruction ◽

Forearm Flap ◽

Radial Forearm ◽

Lip Carcinoma ◽

The Aesthetic ◽

Lip Defect

Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result.

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Novel STSG Donor Site for Forearm Flaps: Radial Skin Paddle

Otolaryngology ◽

10.1016/j.otohns.2008.05.103 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P31-P31

Author(s):

Tamer Abdel-Halim Ghanem ◽

Mark K Wax

Keyword(s):

Free Flap ◽

Medical Center ◽

Donor Site ◽

Free Tissue Transfer ◽

Free Flaps ◽

Patch Repair ◽

Skin Grafts ◽

Skin Paddle ◽

Forearm Skin ◽

Radial Forearm

Objective Split thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial forearm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial. Methods Prospective data was collected from patients undergoing forearm free flap reconstruction at a tertiary medical center in a 6-month period. The radial forearm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after arm tourniquet activation. Results There were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean forearm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non-meshed. Harvesting from the forearm skin paddle was successful in 25 patients (93%). Two patients required a thigh STSG; both patients were octagenerians with frail skin. All the forearm donor sites healed well, except one patient required a later revision procedure for exposed tendon. Conclusions Based on this study, the thigh STSG donor site can be eliminated in 9 out of 10 patients undergoing radial forearm free flaps. This translates to decreased risk of pain, infection, and wound oozing. Older patients with frail skin and atrophied forearm muscles were likely to require a thigh donor site.

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Reconstruction of Oromandibular Defects by Vascularized Free Flaps: The Radial Forearm Free Flap and Fibular Free Flap as Major Donor Sites

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2006.06.286 ◽

2009 ◽

Vol 67 (7) ◽

pp. 1473-1477 ◽

Cited By ~ 18

Author(s):

Raúl González-García ◽

Luis Naval-Gías ◽

Francisco J. Rodríguez-Campo ◽

Leticia Román-Romero

Keyword(s):

Free Flap ◽

Free Flaps ◽

Radial Forearm Free Flap ◽

Radial Forearm ◽

Fibular Free Flap ◽

Major Donor

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Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v5i1.252 ◽

2019 ◽

Vol 5 (1) ◽

pp. 188-194

Author(s):

Parintosa Atmodiwirjo ◽

Tasya Anggrahita

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Free Flaps ◽

Cancer Resection ◽

Free Fibular Flap ◽

Radial Forearm ◽

Mandibular Defect ◽

Fibular Flap

Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.

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Reconstruction of a Mangled Hand with a Thoracodorsal Artery Perforator Free Flap: A Report of Two Cases

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0072 ◽

2021 ◽

Vol 26 (1) ◽

pp. 57-62

Author(s):

Hyun Sik Park ◽

Dong-Jin Kim ◽

Joing Ick Hwang

Keyword(s):

Free Flap ◽

Surgical Flaps ◽

Perforator Flap ◽

Free Flaps ◽

Soft Tissue Defects ◽

Anterolateral Thigh ◽

Thoracodorsal Artery ◽

Radial Forearm ◽

Artery Perforator ◽

Tissue Defects

Mangled hands are a severely injured condition that is a rare and challenging problem for reconstructive surgeons. Surgical flaps such as anterolateral thigh, radial forearm, or thoracodorsal artery flaps have been used for multiple-digit resurfacing. In this report, we describe two cases of complex defects that included multiple digits in patients who underwent reconstruction with thoracodorsal artery perforator (TDAP) free flaps. All massive soft tissue defects were completely covered with a TDAP free flap. The thinner perforator flap could be harvested, and the patients regained the ability to pinch and grasp. Therefore, the authors present two cases of mangled hands successfully treated with TDAP free flap.

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