Luna-Ortiz K, Jaque B, Monnier P, Pasche P

Language: English
References: 25
Page: 77-81
PDF size: 82.88 Kb.

ABSTRACT

Background: This study demonstrates our experience in the use of the radial forearm flap in head and neck surgery and describes the complications that may arise from this procedure. Methods: A prospective analysis of 55 radial forearm flap reconstructions in patients undergoing surgery for head and neck cancers was undertaken between February 1993 and December 1996. There were 53 cases of squamous cell carcinoma (96%), one rhabdomyosarcoma, and one mucoepidermoid carcinoma. Results: Sites of surgical defects were oropharynx in 38 cases (69%), oral cavity in 10 (18%), face in four (7%), and hypopharynx in three (6%). Two flaps could not be left in place, one due to an anatomic abnormality demonstrated by absence of radial artery fasciocutaneous proximal perforations and the other to absence of venous outflow. Arterial and venous thrombosis occurred in eight (15%) patients, with a flap salvage rate of 63% (5/8). Flap loss rate was 9%. Other perioperative local complications included partial necrosis of three flaps, suture dehiscence in five cases, fistula in five cases, and hematoma in four. Eleven patients experienced systemic complications, all with pneumonia, and one died due to septic shock. Long-term complications were trismus in nine patients and local infection in two. The forearm flap allows one-step reconstruction of large tissue defects in the head and neck region. Morbidity at donor site is minimal and easily managed. Flap loss rate is low but continues to be the most important complication.

REFERENCES

1. Yang G, Chen B, Gao Y, et al. Forearm free skin flap transplantation. Natl Med J China 1981;61:139-141.

2. Coleman JJ. Reconstruction of the pharynx after resection for cancer. A comparison of methods. Ann Surg 1989;209:554-561.

3. Urken ML, Vickery C, Weinberg H, Biller HF. The neurofasciocutaneous radial forearm flap in head and neck reconstruction- a preliminary report. Presented at the Annual Meeting of the Trilogical Society. San Francisco, CA, USA, April. Laryngoscope 1990;100:161-173.

4. Soutar D, Widdowson WP. Immediate reconstruction of the mandible using a vascularized segment of radius. Head Neck 1986;8:232-246.

5. Sakai S, Soeda S, Endo T, Ishii M, Uchiumi E. A compound radial artery forearm flap for the reconstruction of lip and chin defect. Br J Plast Surg 1989;42:337-338.

6. Sadove R, Luce EA, McGrath PC. Reconstruction of the lower lip and chin with the composite radial forearm-palmaris longus free flaps. Plast Reconst Surg 1991;88:209-214.

7. Kelly KE, Anthony JP, Singer M. Pharyngoesophageal reconstruction using the radial forearm fasciocutaneous free flap: preliminary results. Otolaryngol Head Neck Surg 1994;111:16-24.

8. Funk GF, Laurenzo JF, Valentino J, McCulloch TM, Frodel JL, Hoffman HT. Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defect. Arch Otolaryngol Head Neck Surg 1995;121:293-303.

9. Luna-Ortiz K, Brossard E, Jaques B, Monnier P, Pasche P. Jejunum free graft for reconstruction of circular defects after total pharyngolaryngectomy. Cir Ciruj 1999;67:11-16.

10. Savant DN, Patel SG, Deshmukh SP, Guajariti R, Bhathena H, Kavarana N. Folded free radial forearm flap for reconstruction of full-thickness defects of the cheek. Head Neck 1995;17:293-296.

11. Dhairyasheel N, Niranja NS, Watson DP. Reconstruction of the cheek using a suspended radial forearm free flap. Br Plast Surg 1990;43:365-366.

12. Sadove RC, Luce EA, McGrath PC. Reconstruction of the lower lip and chin with the composite radial forearm-palmaris longus free flap. Plast Recosnt Surg 1991;88:209-214.

13. Small JO, Millar R. The radial artery forearm flap: an anomaly of the radial artery. Br J Plast Surg 1985;38:501-503.

14. Funk GF, Valentino J, McCulloch TM, Graham SM, Hoffman HT. Anomalies of forearm vascular anatomy encountered during elevation of the radial forearm flap. Head Neck 1995;17:284-292.

15. Klein C, Kovacs A, Stuckensen T. Free arterialized venous forearm flaps for intraoral reconstruction. Br J Plast Surg 1997;50:166-171.

16. Kerrigan CL, Zelt RG, Daniel RK. Secondary critical ischemia time of experimental skin flaps. Plast Reconst Surg 1984;74:522-526.

17. Milton SH. Experimental studies on island flaps. II: Ischemia and delay. Plast Reconst Surg 1972;49:444-447.

18. Babajanian M, Zhang WX, Turk JB, Weinberg H, Biller HF, Urken ML. Temporal factors affecting the secondary critical ischemia of normothermic experimental skin flaps. Arch Otolaryngol Head Neck Surg 1991;117:1360-1364.

19. Zdeblick TA, Sahffer JW, Fiels GA. An ischemia-induced model of revascularization failure of replanted limbs. J Hand Surg 1985;10:125-131.

20. Zdeblick TA, Shaffer JW, Fiels GA. The use of urukinase in ischemic replanted extremities in rats. J Bone Joint Surg Am 1987;69:442-449.

21. Amaes A III, Wright L, Kowada M, Thurston JM, Majno G. Cerebral ischemia. II: The no-reflow phenomenon. Am J Pathol 1968;52:437-447.

22. Chait LA, May JW, O’Brien BM, Hurley JV. The effect of the perfusion of various solutions on the no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg 1978;61:421-430.

23. May JW, Chait LA, O’Brien BM, Hurley JV. The no-reflow phenomenon in experimental free flaps. Plast Reconst Surg 1978;256-267.

24. Stevens DW, Weiss DD, Koller WA, Bianchi DA. Survival of normothermic microvascular flaps after prolonged secondary ischemia: effects of hyperbaric oxygen. Otolaryngol Head Neck Surg 1996;155:360-364.

25. Pang CY, Forrest CR, Morris SF. Pharmacological augmentation of skin flap viability: a hypothesis to mimic the surgical delay phenomenon or wishful thought. Ann Plast Surg 1989;22:293-306.