Using free radial forearm flap in the repair of different soft tissue defects in the head and neck region

Aim: Radial forearm flap (RFF) is a reliable flap that can be easily used to repair tissue defects in all parts of the body, especially inthe areas such as the oral cavity, cheek mucosa and the tongue. It is used for the repair of soft tissue defects as a fasciocutaneousflap, and it is also used as osteo- fasciocutaneous flap, with the radius bone being split into the flap. In this study, we retrospectivelyexamined the cases in which tissue defect repair was performed with free radial forearm flaps in our clinic between the years of2008and 2018. The purpose of this study; is the determination of the results of the use of the radial forearm flap in the reconstructionof different soft tissue defects belonging to the head and neck region.Material and Methods: RFF repair was conducted in 24 patients who were included in our study. 15 of the patients were male and 9were female. The mean age of the patients was 49. The cause of tissue defect was tumoral invasion in 17 patients, trauma (trafficaccident, fall) in 6 patients and gunshot wound in 1 patient.Results: Total flap loss was observed in 1 patient and partial flap loss was seen in 1 patient. No post-operative infection, bleeding orsimilar complications were observed. Donor site problems were observed in 4 patients, while the donor area of 2 patients recoveredafter secondary treatment, while the donor area of the other 2 patients was repaired with additional partial thickness skin grafts.Conclusion: Radial forearm flap with free transfer is an option that has been used safely for many years in many regions, especiallyin intraoral soft tissue defects such as tongue, inner cheek, and the floor of the mouth. Although harvesting of this flap is slightlyeasier than other flaps, it is a procedure that requires meticulousness and patience similar to every area where microsurgery exists.Although sacrificing one of the main vessels of the upper limb with this flap is a serious disadvantage, the advantages it offers,especially in the intraoral defects, still keeps the radial forearm flap popular over the years.

PDF

___

1. Sittitrai P, Reunmakkaew D, Srivanitchapoom C. Submental island flap versus radial forearm free flap for oral tongue reconstruction: a comparison of complications and functional outcomes. J Laryngol Otol 2019;133:413-8.
2. Gao RW, Nuyen BA, Divi V, et al. Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2018;144:746-52.
3. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. British J Plastic Surg 1984;37:149-59.
4. De Virgilio A, Iocca O, Di Maio P, et al. Head and neck soft tissue reconstruction with anterolateral thigh flaps with various components: Development of an algorithm for flap selection in different clinical scenarios. Microsurgery 2019;39:590-7.
5. Yang GF, Chen PJ, Gao YZ, et al. Forearm free skin flap transplantation: a report of 56 cases. 1981. British J Plastic Surg 1997;50:162-5.
6. Garg RK, Wieland AM, Poore SO, et al. The radial forearm snake flap: A novel approach to oral cavity and oropharyngeal reconstruction that reduces forearm donor site morbidity. Microsurgery 2017;37:6-11.
7. Jorgensen MG, Tabatabaeifar S, Toyserkani NM, et al. Submental Island Flap versus Free Flap Reconstruction for Complex Head and Neck Defects. Otolaryngology- -head and neck surgery : Otolaryngol Head Neck Surg 2019;161:946-53.
8. Hsieh WC, Tee R, Chang KP, et al. Aesthetic singlestage vermilion reconstruction using facial artery musculomucosal flap and radial forearm free flap following cancer resection: A case report. Microsurgery 2019.
9. Urken ML, Weinberg H, Buchbinder D, et al. Microvascular Free Flaps in Head and Neck Reconstruction: Report of 200 Cases and Review of Complications. Otolaryngol Head Neck Surg 1994;120:633-40.
10. Sugrue CM, Rooney G, Sugrue RM. Trapezius flaps for reconstruction of head and neck defects following oncological resection - A systematic review. Journal of cranio-maxillo-facial surgery : Maxillo-Facial Surg 2017;45:2115-9.
11. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plastic and Reconstructive Surg 1979;63:73-81.
12. Chen W-L, Wang Y-Y, Zhang D-M, et al. Extended vertical lower trapezius island myocutaneous flap versus pectoralis major myocutaneous flap for reconstruction in recurrent oral and oropharyngeal cancer. Head & Neck 2016;38:159-64.
13. Chen W, Yang Z, Zhang D, et al.Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma. Int J Oral Maxillofac Surg 2014;43:531-8.
14. Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg 2014;30:497-503.
15. Cheng A, Bui T. Submental island flap. Oral Maxillofac Surg Clin North Am 2014;26:371-9.
16. Ayad T, Xie L. Facial artery musculomucosal flap in head and neck reconstruction: Head & Neck 2015;37:1375-86.
17. O'Connell JE, Bajwa MS, Schache AG, et al. Head and neck reconstruction with free flaps based on the thoracodorsal system. Oral Oncology 2017;75:46-53.
18. Guerra AB, Lyons GD, Dupin CL, et al. Ear Nose Throat J 2005;84:441-7.
19. Hung WY, Tung CC, Fang WY, et al. Free Flap Transfer for Head and Neck Reconstruction Using Local Anesthesia in Elderly Patients. Ann Plast Surg 2018;80:30-5.
20. Ince B, Yarar S, Dadaci M. Simultaneous flap thinning with ultrasound-assisted liposuction during free flap surgery: Preliminary results. Microsurgery 2019;39:144-9.
21. Yang XD, Zhao SF, Wang YX, et al. Use of Extended Lateral Upper Arm Free Flap for Tongue Reconstruction After Radical Glossectomy for Tongue Cancer. Aesthetic Plast Surg 2015;39:562-9.
22. Masià J, Sommario M, Cervelli D, et al. Extended deep inferior epigastric artery perforator flap for head and neck reconstruction: a clinical experience with 100 patients. Head & Neck 2011;33:1328-34.
23. Ahmad FI, Means C, Labby AB, et al. Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction. Head & Neck 2017;39:1888-93.
24. Gurunluoglu R, Gatherwright J. Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm. Microsurgery 2019;39:384-94.
25. Spaulding SL, Yue LE, O'Malley QF, et al. A novel radial forearm free flap design to treat pharyngoesophageal stenosis in combination with the posterior wall of the trachea. J Surg Oncol 2019;120:1446-9.
26. Mashrah MA, Lingjian Y, Handley TP, et al. Novel technique for the direct closure of the radial forearm flap donor site defect with a local bilobed flap. Head & Neck 2019;41:3282-9.
27. Halama D, Dreilich R, Lethaus B, et al. Donor-site morbidity after harvesting of radial forearm free flaps-comparison of vacuum-assisted closure with conventional wound care: A randomized controlled trial. Journal of cranio-maxillo-facial surgery : Maxillo-Facial Surg 2019;47:1980-5.