The indications and outcomes in the use of osteocutaneous radial forearm free flap

被引:89
作者
Villaret, DB
Futran, NA
机构
[1] Univ Florida, Dept Otolaryngol, Gainesville, FL 32608 USA
[2] Univ Washington, Dept Otolaryngol, Seattle, WA 98195 USA
来源
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK | 2003年 / 25卷 / 06期
关键词
radial forearm flap; osteofasciocutaneous flaps; mandible and maxilla reconstruction; head and neck reconstruction;
D O I
10.1002/hed.10212
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Introduction. Whether secondary to cancer surgery ablation or trauma, surgeons are faced with defects of the mandible or maxilla that would be best reconstructed with a thin, pliable soft tissue component and vascularized bone. A subset of these challenging wounds do not require the bicortical bone necessary to reestablish structural integrity or to retain a dental prosthesis, because the soft tissue needs are more critical than the bony needs. It is this niche that the radial forearm osteofaciocutaneous free flap (RFOFF) fulfills well. In the past, potential and real donor site morbidity has precluded the routine use of this flap. New methods to reduce this morbidity have rekindled our use of this flap. Procedures Used. A retrospective review of patients with defects of the mandible or maxilla treated with the RFOFF from July 1, 1997, to December 31, 2000, was performed. After flap harvest, the donor site was rigidly fixated. A skin graft was placed, and a volar splint was applied for 7 days. The arm was then fully mobilized. Parameters examined were defect location, donor site complications, flap survival, fistula occurrence, plate fracture, and/or extrusion. Results. Thirty-four patients were reconstructed with the RFOFF with a follow-up of 10-54 months. Seven patients had an anterior maxillectomy defect, and 27 patients had a lateral mandibulectomy defect with associated tongue/tonsillar fossa and/or palate defect. There were no cases of flap failure or donor site radius fracture. During the follow-up period, there were no plate fractures or intraoral exposures as evidenced by clinical and radiographic evaluation. Fistulas occurred in five patients; all healed without surgical intervention. Conclusion. With rigid fixation of the residual radius, donor site morbidity has been minimized, and indications for this flap have expanded. Specifically the anterior maxillary arch and the ascending ramus, angle, and posterior body of the mandible (nontooth-bearing areas) are the sites most amenable to the thin bony stock of the harvested radius. The pliable forearm skin is ideal for the soft tissue defects. We believe that the RFOFF with bone has a definite role in the reconstruction of select head and neck defects. (C) 2003 Wiley Periodicals, Inc.
引用
收藏
页码:475 / 481
页数:7
相关论文
共 21 条
[1]   Volume-length impact of lateral jaw resections on complication rates [J].
Arden, RL ;
Rachel, JD ;
Marks, SC ;
Dang, K .
ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, 1999, 125 (01) :68-72
[2]   REDUCING MORBIDITY IN THE RADIAL FOREARM FLAP DONOR SITE [J].
BARDSLEY, AF ;
SOUTAR, DS ;
ELLIOT, D ;
BATCHELOR, AG .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1990, 86 (02) :287-292
[3]  
Blackwell KE, 1996, ARCH OTOLARYNGOL, V122, P672
[4]   The bridging lateral mandibular reconstruction plate revisited [J].
Blackwell, KE ;
Lacombe, V .
ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, 1999, 125 (09) :988-993
[5]   Osteocutaneous radial forearm free flaps - The necessity of internal fixation of the donor-site defect to prevent pathological fracture [J].
Bowers, KW ;
Edmonds, JL ;
Girod, DA ;
Jayaraman, G ;
Chua, CP ;
Toby, EB .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2000, 82A (05) :694-704
[6]   THE FREE-FLAP AND PLATE IN OROMANDIBULAR RECONSTRUCTION - LONG-TERM REVIEW AND INDICATIONS [J].
BOYD, JB ;
MULHOLLAND, RS ;
DAVIDSON, J ;
GULLANE, PJ ;
ROTSTEIN, LE ;
BROWN, DH ;
FREEMAN, JE ;
IRISH, JC .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1995, 95 (06) :1018-1028
[7]   A classification system and algorithm for reconstruction of maxillectomy and midfacial defects [J].
Cordeiro, PG ;
Santamaria, E .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2000, 105 (07) :2331-2346
[8]   The radial forearm osteocutaneous "sandwich" free flap for reconstruction of the bilateral subtotal maxillectomy defect [J].
Cordeiro, PG ;
Bacilious, N ;
Schantz, S ;
Spiro, R .
ANNALS OF PLASTIC SURGERY, 1998, 40 (04) :397-402
[9]   A COMPARISON OF THE RESULTS FOLLOWING OROMANDIBULAR RECONSTRUCTION USING A RADIAL FOREARM FLAP WITH EITHER RADIAL BONE OR A RECONSTRUCTION PLATE [J].
DAVIDSON, J ;
BOYD, B ;
GULLANE, P ;
ROTSTEIN, L ;
FREEMAN, J ;
MANKTELOW, R ;
ROSEN, I .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1991, 88 (02) :201-208
[10]  
Foster RD, 1996, ARCH SURG-CHICAGO, V131, P960