Comparison of radial forearm flap and thoracodorsal artery perforator flap donor site morbidity for reconstruction of oral and oropharyngeal defects in head and neck cancer

Bach, C.; Dreyfus, Jean‐François; Wagner, I.; Lachiver, X.; Guth, A.; Chabolle, F.

doi:10.1016/j.anorl.2015.06.003

Cited by 16 publications

(10 citation statements)

References 18 publications

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“…In general, patients are primarily concerned about defects related to the donor site healing and moving in the early postoperative period. However, over time, their concerns shift to numbness, paresthesia, itching, joint dysfunction, and certain aesthetic problems, such as hypertrophic scarring, pigmentation, and limb deformity ( 2 , 6 , 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison between free posterior tibial flap and free radial forearm flap for head and neck reconstruction: an anatomical study and a retrospective comparative cohort study

Fang¹,

Huang²,

Zhang³

et al. 2022

Ann Transl Med

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Background: Both free posterior tibial flap (FPTF) and free radial forearm flap (FRFF) are commonly used for head and neck defects. They have many similarities in embryology, histology, and anatomy, but their advantages and disadvantages in head and neck repair have not been fully recognized. This study aimed to compare the cadaveric anatomy and clinical application of FPTF and FRFF for the reconstruction of head and neck defects after tumor resection.Methods: Anatomical dissection was performed on 10 fresh adult cadavers. The general characteristics of both flaps and the sites of recipients and donors were collected. A total of 31 and 25 patients underwent FPTF and FRFF construction, respectively. The patient medical records were assessed to obtain the clinical characteristics. Characteristics of the flap such as size, pedicle length, and clinical process data were collected and compared. The appearance, sensory disturbance, and effect on quality of life and daily activity were evaluated.Results: The posterior tibial artery was present and observed in all patients. The posterior vascular pedicle was longer than the radial artery. There was no difference between the diameters of arteries of FPTF and FRFF; however, the diameters of their veins differed. In terms of flap characteristics, FPTF was significantly larger and had a longer vascular pedicle than FRFF (40.68±11.07 vs. 53.77±29.02 cm 2 , P=0.03; 8.48±1.66 vs.

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Section: Discussionmentioning

confidence: 99%

Comparison between free posterior tibial flap and free radial forearm flap for head and neck reconstruction: an anatomical study and a retrospective comparative cohort study

Fang¹,

Huang²,

Zhang³

et al. 2022

Ann Transl Med

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Section: Discussionmentioning

confidence: 99%

“…The RFFF remains a mainstay in H&N reconstruction surgery, although the anterolateral thigh free flap and the thoracodorsal artery perforator free flap are being increasingly used. 17,18 Preservation of donor site function is important when considering the free flap harvest site. The RFFF has been associated with donor site morbidity, including attenuated grip strength, reduced wrist range of motion, edema, dysesthesia in the area innervated by the superficial branch of the radial nerve, cold intolerance, the formation of a poor transplant site for split-thickness skin grafts, and the risk of problems with wound healing due to moving tendons.…”

Section: Discussionmentioning

confidence: 99%

“…Potential complications include a decrease in wrist range of motion, reduced grip strength, diminished sensation, painful neuroma, skin graft loss over the donor site resulting in tendon exposure, numbness, itching, cold intolerance, poor aesthetic appearance, limited finger range of motion, and delayed healing 3‐6 . Tendon exposure is the most common complication, with a prevalence between 6% and 53%, 7,8 and up to 30% of patients have significant problems with healing after coverage with a thin or full skin graft 9 . Often considered as minor complications, many recent articles have underlined the handicap and morbidity of harvesting an RFFF, especially with regard to the benefits of perforator flaps 10,11 .…”

mentioning

confidence: 99%

“…[3][4][5][6] Tendon exposure is the most common complication, with a prevalence between 6% and 53%, 7,8 and up to 30% of patients have significant problems with healing after coverage with a thin or full skin graft. 9 Often considered as minor complications, many recent articles have underlined the handicap and morbidity of harvesting an RFFF, especially with regard to the benefits of perforator flaps. 10,11 With secondary tendon exposure, minor defects are usually left to heal spontaneously; otherwise, a skin graft can be used even in the absence of paratenon on the exposed tendon.…”

mentioning

confidence: 99%

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Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap

Foissac

Benatar

Dassonville

et al. 2017

Otolaryngol.--head neck surg.

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Objective This study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery. Study Design Prospective cohort study. Setting Plastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France. Subjects and Methods Despite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure. Conventional skin grafts for secondary tendon exposure can lead to diminished wrist range of motion and grip strength, with residual pain and cold intolerance. Between 2012 and 2015, we prospectively studied 20 patients with secondary tendon exposure after a forearm radial free flap for head and neck reconstruction. Two techniques of secondary coverage were compared: a reference technique with a secondary full skin graft (10 patients) and a dorsoulnar artery perforator (DUAP) flap (10 patients). Results Maximum wrist extension (100%) was observed for the DUAP group compared with only 87% for the skin graft (SG) group ( P = .001). An improvement in grip strength (+14 kg) ( P = .028) and a decrease in pain or cold intolerance ( P = .002) were also observed in the DUAP group, in addition to a better aesthetic appearance. Conclusion The perforator flap procedure is an interesting tool in reconstructive surgery. The DUAP flap is a reliable, useful flap for secondary tendon exposure coverage after a radial forearm free flap. Level of Evidence III (case-control analytic studies of 1 center).

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Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect

Kinkhabwala,

Amin,

Rist

et al. 2024

Head & Neck

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BackgroundPartial or total laryngopharyngectomy defects have traditionally been reconstructed using the radial forearm, anterolateral thigh, or jejunal free flaps. The latissimus dorsi myocutaneous free flap (LDMFF) is an option for high‐risk patients with complex laryngopharyngeal ± cutaneous neck defects.MethodsRetrospective single‐surgeon case series from 2017 to 2022. Outcomes were assessed at both the back donor site and head and neck.ResultsTwenty‐four patients were identified. Flap survival was 100%. There was 1 (4.2%) pharyngocutaneous fistula and 2 (8.3%) tracheo‐esophageal peristomal fistulas. At last follow‐up, 17 (71%) were sustaining weight on oral intake, and 7 (29%) were G‐tube dependent with 4 of these able to do some type of oral intake. Seven (29.2%) had post‐operative stricture/stenosis requiring dilation. There were only minor donor site complications, all managed conservatively.ConclusionsThe LDMFF can be a robust reconstructive option, particularly for radiated high‐risk patients with complex pharyngeal defects, including skin.

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Comparison of radial forearm flap and thoracodorsal artery perforator flap donor site morbidity for reconstruction of oral and oropharyngeal defects in head and neck cancer

Abstract: This is the first study to compare radial forearm and thoracodorsal artery perforator free flap donor site scars. It demonstrates the minimal TDAP donor site morbidity and the high level of patient satisfaction.

Cited by 16 publications

References 18 publications

Comparison between free posterior tibial flap and free radial forearm flap for head and neck reconstruction: an anatomical study and a retrospective comparative cohort study

Comparison between free posterior tibial flap and free radial forearm flap for head and neck reconstruction: an anatomical study and a retrospective comparative cohort study

Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap

Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect

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