Reconstruction of medium-size defects of the oral cavity: radial forearm free flap vs facial artery musculo-mucosal flap

Abstract Background The radial forearm free flap (RFFF) is the most commonly used flap for defects of the oral cavity. The facial artery musculomucosal (FAMM) is a safe and effective method to reconstruct medium sized defects of the oral cavity. No comparison exists between the FAMM flap and RFFF. Methods 1) Retrospective chart review from 2007 to 2016. 2) Cost difference analysis. Results Thirteen FAMM flap cases and 18 RFFF met inclusion criteria. The FAMM flap showed a tendency to lower rates of return to the operating room (p = 0.065) as well as lower rates of complications not requiring return to the OR with 1 complication in 1 patient as opposed to 10 patients with 15 complications (p = 0.008). Also, FAMM flap had shorter operative times compared to the RFFF group (7.2HR and 8.9 HR respectively, p = 0.002). The average operative room related costs for a FAMM flap were 6510 CAD vs 10,703 CAD for RFFF (p < 0.0005). Speech and swallowing outcomes were similar (p > 0.05). Conclusion The FAMM flap can be used for reconstruction of medium-size defects of the oral cavity with functional outcomes similar to the RFFF while decreasing the associated costs and morbidity. Graphical Abstract

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Free radial forearm flap for reconstruction of postoperative defects in combined and complex treatment of patients with locally-advanced squamous cell carcinoma of the oral cavity

Head and neck tumors (HNT) ◽

10.17650/2222-1468-2020-10-1-55-64 ◽

2020 ◽

Vol 10 (1) ◽

pp. 55-64

Author(s):

H. Chen ◽

A. M. Mudunov ◽

R. I. Azizian ◽

I. N. Pustynskiy ◽

O. A. Saprina ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Free Flap ◽

Locally Advanced ◽

Functional Results ◽

Radial Forearm Free Flap ◽

Flap Necrosis ◽

Radial Forearm

The study objective is to assess immediate and long-term results of replacing complex defects with a free radial forearm flap in the multimodal treatment of patients with locally advanced oral cavity squamous cell carcinoma. Materials and methods. Twenty eight patients (20 women and 8 men aged 23 to 71 years) with locally advanced oral cavity squamous cell carcinoma (including 10 buccal cancers, 8 carcinomas of tongue, 6 carcinomas of the floor of the mouth, 2 retromolar area carcinomas, 1 carcinoma of the hard palate and 1 carcinoma of alveolar region of the lower jaw) underwent tumor surgery with simultaneous plastic reconstruction of the defect using radial forearm free flap at the department of head and neck tumors of N. N. Blokhin National Medical Research Center of Oncology within 2010–2018. Primary tumors were detected in 2 patients and 11 patients had residual (n = 7) or recurrent (n = 4) tumors after radiotherapy or chemoradiotherapy. Results. An overall success rate was 96.4 %. Postoperative histology revealed that there were no tumor cells at the resection edges. Postoperative complications included: complete flap necrosis in 1 patient with severe concomitant diseases, marginal flap necrosis in 2 patients (in both cases after the necrotic tissue had rejected, wounds were healed by secondary intention), sural veins thrombosis in 1 patient, acute peptic ulcer bleeding on the 6th day after surgery in 1 patient treated with emergency endoscopic hemostasis. No lethal outcomes were reported. Postoperative period lasted in average 14 days. Upon subsequent observation tumor relapse in the oral cavity occurred in 4 (14.3 %) patients, relapses of regional metastases – in 2 (7.1 %). Good aesthetic and functional results were noted. Adequate restoration of breathing, chewing, swallowing and speaking resulted in a full patients’ rehabilitation. In all cases, the radial flap adapted well to the oral cavity organs and corresponded to the surrounding tissues in thickness and consistency. Conclusion. Use of a radial forearm free flap makes it possible to successfully reconstruct extensive and complex defects after surgery of locally advanced primary and recurrent forms of oral cavity squamous cell cancer of various locations. Due to flap’s high regenerative capabilities, preoperative radiation therapy does not affect the frequency of local complications. It allows restoring vital functions of the oral cavity and achieving good aesthetic and functional results.

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Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report

World Journal of Surgical Oncology ◽

10.1186/s12957-018-1492-5 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Shuai Wang ◽

Zeliang Zhang ◽

Zhongfei Xu ◽

Weiyi Duan

Keyword(s):

Case Report ◽

Free Flap ◽

Facial Artery ◽

Radial Forearm Free Flap ◽

Upper Lip ◽

Kite Flap ◽

Radial Forearm ◽

Lip Defect

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Comparison Between Radial Forearm Free Flap and Pectoralis Major Myocutaneous Flap for Reconstruction in Oral Cavity Cancer Patients

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000008423 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Cheng-Feng Zhang ◽

Xiang-Jun Liu ◽

Dong-Wei Liu ◽

Xu Zhang

Keyword(s):

Oral Cavity ◽

Cancer Patients ◽

Free Flap ◽

Oral Cavity Cancer ◽

Myocutaneous Flap ◽

Pectoralis Major ◽

Pectoralis Major Myocutaneous Flap ◽

Radial Forearm Free Flap ◽

Radial Forearm

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Aesthetic single‐stage vermilion reconstruction using facial artery musculomucosal flap and radial forearm free flap following cancer resection: A case report

Microsurgery ◽

10.1002/micr.30456 ◽

2020 ◽

Vol 40 (2) ◽

pp. 224-228 ◽

Cited By ~ 1

Author(s):

Wei‐Chuan Hsieh ◽

Richard Tee ◽

Kai‐Ping Chang ◽

Jung‐Ju Huang

Keyword(s):

Case Report ◽

Free Flap ◽

Single Stage ◽

Facial Artery ◽

Radial Forearm Free Flap ◽

Cancer Resection ◽

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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