scholarly journals V-shaped radial forearm free flap is a new way to reduce the morbidity of the donor area

2021 ◽  
Vol 23 (3) ◽  
pp. 513-517
Author(s):  
Mikhail V. Bolotin ◽  
Ali М. Mudunov ◽  
Ali М. Mudunov ◽  
Vasilii Yu. Sobolevsky ◽  
Azer А. Akhundov ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Locally Advanced ◽  
Head And Neck Reconstruction ◽  
Skin Area ◽  
Radial Forearm Free Flap ◽  
Direct Closure ◽  
Aesthetic Result ◽  
Donor Area ◽  
Radial Forearm

Background. Radial forearm free flap is one of the most frequently used in the head and neck reconstruction. A significant disadvantage is the appearance of the donor site. We have developed and introduced into clinical practice a V-shaped fabrication skin of the flap, which allows direct closure of the donor site and reduces morbidity. Aim. To assess the possibility of direct closure of the donor site and to reduce the morbidity of the donor site when performing the V-shaped fabrication of the skin area of the flap. Materials and methods. During the period from 2014 to 2020, the radial free flap was used in 43 cases. In 15 (35%) cases, a V-shaped fabrication of the skin area was used during flap harvest, which made it possible to carry out a direct closure of the donor site. The length of the skin area stretched from the top of the wrist, not reaching 34 cm to the elbow bend and varied from 715 cm, on average 12 cm. The width of the flap was determined by the elasticity of the forearm skin, was maximum in the middle third and varied from 2 up to 4 cm, averaging 3.3 cm. If necessary, the upper and lower edges of the skin area can be sutured together, as well as the entire medial edge of the flap. This technique increases the flap width by almost 2 times. This arrangement was applied in 8 cases. Results. When comparing the results of using the two techniques, the following data were obtained: "V-shaped" fabrication of the skin was used mainly in women (11/15 73%) for reconstruction limited defects in the retromolar region (5/15), soft (4/15) or hard palate (6/15). Most of the patients had localized T1-T2 (10/15) stage. None of the patients had any problems with the healing of the donor area. An excellent aesthetic result was obtained in all patients. In the group of standard harvest, the predominance of males was noted (17/28). Defects had a varied localization, most patients was with relapses after chemo-radiation treatment (10/28) or primary locally advanced T3-T4 stage process (6/28) 16, with a localized T1-T2 stage (11/28) 11, in one case, delayed reconstruction was performed. In all cases, the plastic of the donor site was performed with a split skin autograft. Partial necrosis of the donor site flap was observed in 9 patients (32%), in 4 cases with exposure of the flexor muscle tendon. Conclusion. As a result of the comparative analysis of the two methods, we concluded that the use of V-shaped fabrication of the skin area of the radial forearm flap allows to obtain better aesthetic results of the donor site, however, the use of this technique leads to a significant reduction in the length of the vascular pedicle and a decrease in the width of the flap.

Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap

2017 ◽  
Vol 33 (08) ◽  
pp. 544-548 ◽  
Author(s):  
Adam Satteson ◽  
Joshua Waltonen ◽  
Zhongyu Li ◽  
Ethan Wiesler ◽  
Peter Apel ◽  
...  
Keyword(s):  
Skin Graft ◽  
Free Flap ◽  
Donor Site ◽  
Graft Loss ◽  
Radius Fracture ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Radial Forearm Free Flap ◽  
Hardware Complications ◽  
Radial Forearm

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.

Endoscopic-Assisted Radial Forearm Free Flap Harvest: A Novel Technique to Reduce Donor Site Morbidity

2018 ◽  
Vol 35 (01) ◽  
pp. 022-030 ◽  
Author(s):  
Emily Van Kouwenberg ◽  
Alan Yan ◽  
Ashit Patel ◽  
Rick McLaughlin ◽  
Patricia Northrup ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Cephalic Vein ◽  
Functional Score ◽  
Head And Neck Reconstruction ◽  
Radial Forearm Free Flap ◽  
Novel Technique ◽  
Patient Reported ◽  
Radial Forearm

Background The radial forearm free flap (RFFF) remains a workhorse flap but can have significant donor site morbidity. The authors developed a novel technique for endoscopic-assisted RFFF (ERFFF) harvest and hypothesized improved donor site morbidity. Methods A retrospective cohort study was conducted evaluating patients who underwent ERFFF or RFFF by a single surgeon for head and neck reconstruction between November 2011 and July 2016; outcomes and complications were compared. A telephone survey was conducted to assess patient satisfaction with donor site appearance and function. Results Twenty-seven ERFFF and 13 RFFF harvests were performed. The cephalic vein was less commonly incorporated in ERFFF patients compared with RFFF patients (3.70 and 38.46%, respectively, p = 0.0095). ERFFF patients had lower rates of wound healing complications (0% vs. 15.38%, p = 0.10) and perfusion-related complications than RFFF patients (3.70% vs. 23.08%, p = 0.092). Fewer ERFFF patients reported a desire for a more normal appearance (42.86% vs. 71.43%, p = 0.361). The ERFFF group had a higher functional score (64.29% vs. 44.44%, p = 0.101), reporting lower rates of associated discomfort (35.71% vs. 85.71%, p = 0.063). None of the differences in rates of complications or patient-reported outcomes between the groups reached statistical significance. Conclusion ERFFF is safe and effective alternative to RFFF, with similar operative time, similar pedicle safety, and elimination of the lengthy forearm incision. Unnecessary cephalic vein dissection can be avoided with endoscopic visualization of the venae comitantes. Further research with a larger sample size and better standardization is needed to assess effects on donor-site morbidity.

A novel Design of V-shaped Radial Forearm Free Flap Facilitates the Direct Closure of Donor Site Wound

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hao Li ◽  
Wenguang Xu ◽  
Yuxin Wang ◽  
Zhe Liu ◽  
Yazhou Cao ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Radial Forearm Free Flap ◽  
Direct Closure ◽  
Radial Forearm ◽  
Novel Design

scholarly journals Radial forearm free flap in a patient with an unusual radial artery variation: a case report

2021 ◽  
Vol 48 (6) ◽  
pp. 646-650
Author(s):  
Giulio Menichini ◽  
Sara Calabrese ◽  
Nicola Alfonsi ◽  
Marco Innocenti
Keyword(s):  
Head And Neck ◽  
Radial Artery ◽  
Free Flap ◽  
Verrucous Carcinoma ◽  
The Body ◽  
Head And Neck Reconstruction ◽  
Soft Tissue Reconstruction ◽  
Radial Forearm Free Flap ◽  
Skin Paddle ◽  
Radial Forearm

Head and neck reconstruction poses unique challenges in rehabilitating surgical defects in terms of integrity, function, and form. The radial forearm free flap (RFFF) has been widely used for defect coverage, especially in the head and neck area, but its versatility allows it to be used for soft-tissue reconstruction in various parts of the body. The vascular features of the flap are quite constant and reliable. Nevertheless, abnormalities of the forearm vascular tree have been described over the decades. We report a case of intraoral reconstruction after verrucous carcinoma recurrence in a 74-year-old woman with an unusual forearm flap, which we called the median forearm free flap, based on a median branch of the radial artery that was preoperatively detected using handheld Doppler ultrasonography. The distally located skin paddle was predominantly supplied by the aberrant median vessel with its perforators. The flap was thus safely harvested with this atypical pedicle. Successful reconstruction of the intraoral defect was achieved, with an uneventful postoperative course.

scholarly journals 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

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.

Subjective morbidity following radial free flap reconstruction in head and neck tumour patients

2019 ◽  
Vol 133 (03) ◽  
pp. 230-235 ◽  
Author(s):  
A Minkara ◽  
M R Simmons ◽  
A Goodale ◽  
Y J Patil
Keyword(s):  
Free Flap ◽  
Short Form ◽  
Donor Site ◽  
Radial Forearm Free Flap ◽  
Short Musculoskeletal Function Assessment ◽  
Neck Tumour ◽  
Radial Forearm ◽  
Musculoskeletal Function ◽  
Assessment Questionnaire ◽  
Function Assessment

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.

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

2006 ◽  
Vol 118 (5) ◽  
pp. 1171-1177 ◽  
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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