Download PDF
J Reconstr Microsurg 2016; 32(05): 361-365
DOI: 10.1055/s-0035-1571251
Original Article: WSRM 2015 Scientific Paper
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Expanding the Utilization of the Osteocutaneous Radial Forearm Free Flap beyond Mandibular Reconstruction

Dustin A. Silverman
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Wojciech H. Przylecki
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Yelizaveta Shnayder
2   Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Terance T. Tsue
2   Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Douglas A. Girod
2   Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Brian T. Andrews
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
2   Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
› Author Affiliations
Further Information

Publication History

27 September 2015

28 November 2015

Publication Date:
05 February 2016 (online)

    Permissions and Reprints

Abstract

Background The osteocutaneous radial forearm free flap (OCRFFF) for mandibular reconstruction has been well described. Despite this flap's utility in the repair of such defects, the indications for the OCRFFF have continued to expand in recent years. The advantages of the OCRFFF allow for a high degree of versatility in the reconstruction of the various anatomical and aesthetic units of the head and neck. In this review, the authors aim to explore the successful utilization of the OCRFFF beyond the reconstruction of composite mandibular defects.

Methods A retrospective chart review was performed. All subjects who underwent OCRFFF reconstruction at a tertiary academic center between January 2004 and December 2014 were identified. A total of six patients undergoing this procedure for indications other than composite mandibular defects of the head and neck were included.

Results A total of six patients underwent OCRFFF reconstruction for correction of nonmandibular defects. Flap success was experienced in six of six cases (100%). Indications included midface maxillary reconstruction (N = 2), orbit reconstruction (N = 1), frontal sinus and forehead reconstruction (N = 2), and subglottic stenosis reconstruction (N = 1). There were no immediate perioperative complications. On long-term follow-up, one subject developed a nasocutaneous fistula following radiation and eventually required maxillary hardware removal.

Conclusion As a result of its growing role and versatility, the OCRFFF should be incorporated as a multipurpose tool in the armamentarium of reconstructive microvascular surgeons in the repair of composite head and neck defects beyond the mandible.

Keywords

osteocutaneous radial forearm free flap reconstruction - aesthetic units - complications
 

  • References

  • 1 Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 2000; 105 (7) 2331-2346 , discussion 2347–2348
    CrossrefPubMedGoogle Scholar
  • 2 Santamaria E, Cordeiro PG. Reconstruction of maxillectomy and midfacial defects with free tissue transfer. J Surg Oncol 2006; 94 (6) 522-531
    CrossrefPubMedGoogle Scholar
  • 3 Muresan C, Hui-Chou HG, Dorafshar AH, Manson PN, Rodriguez ED. Forehead reconstruction with microvascular flaps: utility of aesthetic subunits. J Reconstr Microsurg 2012; 28 (5) 319-326
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Hicks DL, Watson D. Soft tissue reconstruction of the forehead and temple. Facial Plast Surg Clin North Am 2005; 13 (2) 243-251 , vi
    CrossrefPubMedGoogle Scholar
  • 5 Singh DJ, Bartlett SP. Aesthetic considerations in nasal reconstruction and the role of modified nasal subunits. Plast Reconstr Surg 2003; 111 (2) 639-648 , discussion 649–651
    CrossrefPubMedGoogle Scholar
  • 6 Rahman M, Jefferson N, Stewart DA, Oliver R, Walsh WR, Gianoutsos MP. The histology of facial aesthetic subunits: implications for common nasal reconstructive procedures. J Plast Reconstr Aesthet Surg 2010; 63 (5) 753-756
    CrossrefPubMedGoogle Scholar
  • 7 Arganbright JM, Tsue TT, Girod DA , et al. Outcomes of the osteocutaneous radial forearm free flap for mandibular reconstruction. JAMA Otolaryngol Head Neck Surg 2013; 139 (2) 168-172
    CrossrefPubMedGoogle Scholar
  • 8 Silverman DA, Przylecki WH, Arganbright JM , et al. Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: An 8-year review of complications and flap survival. Head Neck 2014; (e-pub ahead of print). doi:10.1002/hed.23919
    PubMedGoogle Scholar
  • 9 Militsakh ON, Werle A, Mohyuddin N , et al. Comparison of radial forearm with fibula and scapula osteocutaneous free flaps for oromandibular reconstruction. Arch Otolaryngol Head Neck Surg 2005; 131 (7) 571-575
    CrossrefPubMedGoogle Scholar
  • 10 Bowers KW, Edmonds JL, Girod DA, Jayaraman G, Chua CP, Toby EB. Osteocutaneous radial forearm free flaps. The necessity of internal fixation of the donor-site defect to prevent pathological fracture. J Bone Joint Surg Am 2000; 82 (5) 694-704
    CrossrefPubMedGoogle Scholar
  • 11 Werle AH, Tsue TT, Toby EB, Girod DA. Osteocutaneous radial forearm free flap: its use without significant donor site morbidity. Otolaryngol Head Neck Surg 2000; 123 (6) 711-717
    CrossrefPubMedGoogle Scholar
  • 12 Shnayder Y, Tsue TT, Toby EB, Werle AH, Girod DA. Safe osteocutaneous radial forearm flap harvest with prophylactic internal fixation. Craniomaxillofac Trauma Reconstr 2011; 4 (3) 129-136
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Avery CM. Review of the radial free flap: still evolving or facing extinction? Part two: osteocutaneous radial free flap. Br J Oral Maxillofac Surg 2010; 48 (4) 253-260
    CrossrefPubMedGoogle Scholar
  • 14 Villaret DB, Futran NA. The indications and outcomes in the use of osteocutaneous radial forearm free flap. Head Neck 2003; 25 (6) 475-481
    CrossrefPubMedGoogle Scholar
  • 15 Urken ML. Composite free flaps in oromandibular reconstruction. Review of the literature. Arch Otolaryngol Head Neck Surg 1991; 117 (7) 724-732
    CrossrefPubMedGoogle Scholar
  • 16 Frederick JW, Sweeny L, Carroll WR, Peters GE, Rosenthal EL. Outcomes in head and neck reconstruction by surgical site and donor site. Laryngoscope 2013; 123 (7) 1612-1617
    CrossrefPubMedGoogle Scholar
  • 17 Chepeha DB, Moyer JS, Bradford CR, Prince ME, Marentette L, Teknos TN. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects. Arch Otolaryngol Head Neck Surg 2005; 131 (6) 513-517
    CrossrefPubMedGoogle Scholar
  • 18 Cordeiro PG, Bacilious N, Schantz S, Spiro R. The radial forearm osteocutaneous “sandwich” free flap for reconstruction of the bilateral subtotal maxillectomy defect. Ann Plast Surg 1998; 40 (4) 397-402
    CrossrefPubMedGoogle Scholar
  • 19 Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg 2002; 128 (2) 161-166
    CrossrefPubMedGoogle Scholar
  • 20 Andrades P, Rosenthal EL, Carroll WR, Baranano CF, Peters GE. Zygomatic-maxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flap. Head Neck 2008; 30 (10) 1295-1302
    CrossrefPubMedGoogle Scholar
  • 21 Sullivan CD, Poetker DM. Anterior table remodeling after treatment for Pott's puffy tumor. Am J Otolaryngol 2013; 34 (3) 265-267
    CrossrefPubMedGoogle Scholar
  • 22 Shin JW, Choi IG, Jung SN, Kwon H, Shon WI, Moon SH. Pott puffy tumor appearing with a frontocutaneous fistula. J Craniofac Surg 2012; 23 (2) e158-e160
    CrossrefPubMedGoogle Scholar
  • 23 Akiyama K, Karaki M, Mori N. Evaluation of adult Pott's puffy tumor: our five cases and 27 literature cases. Laryngoscope 2012; 122 (11) 2382-2388
    CrossrefPubMedGoogle Scholar
  • 24 Bluebond-Langner R, Jackowe D, Rodriguez ED. Simultaneous obliteration and treatment of infected frontal sinus fractures: novel use of the fibula flap. J Craniofac Surg 2007; 18 (3) 680-683
    CrossrefPubMedGoogle Scholar
  • 25 Al-Khudari S, Sharma S, Young W, Stapp R, Ghanem TA. Osteocutaneous radial forearm reconstruction of large partial cricotracheal defects. Head Neck 2013; 35 (8) E254-E257
    CrossrefPubMedGoogle Scholar
  • 26 Fujiwara T, Nishino K, Numajiri T. Tracheal reconstruction with a prefabricated and double-folded radial forearm free flap. J Plast Reconstr Aesthet Surg 2009; 62 (6) 790-794
    CrossrefPubMedGoogle Scholar
  • 27 Teng MS, Malkin BD, Urken ML. Prefabricated composite free flaps for tracheal reconstruction: a new technique. Ann Otol Rhinol Laryngol 2005; 114 (11) 822-826
    CrossrefPubMedGoogle Scholar
  • 28 Yu P, Clayman GL, Walsh GL. Human tracheal reconstruction with a composite radial forearm free flap and prosthesis. Ann Thorac Surg 2006; 81 (2) 714-716
    CrossrefPubMedGoogle Scholar