Experience with the Radial Forearm Flap in 14 Cases

Matthews, R.N.; Fatah, Fazel; Davies, David G.; Eyre, James; Hodge, Rachel; Walsh-Waring, G. P.

doi:10.3109/02844318409052855

Cited by 21 publications

(14 citation statements)

References 10 publications

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“…[1][2][3]13,15 Early reports of its use identify a history of such complications. 2,[20][21][22] In a series of 14 radial forearm flaps, Matthews et al 21 emphasized that venous congestion was more marked in cases that relied on retrograde venous flow. Soutar and Tanner 2 encountered venous congestion in a reverse flow flap that led to necrosis and delayed primary healing, which he salvaged by anastomosis of the cephalic vein to a dorsal hand vein.…”

Section: Discussionmentioning

confidence: 98%

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications

White

Steve

Buchel

et al. 2016

Annals of Plastic Surgery

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The pedicled reverse radial forearm flap is a well-known option for the treatment of a variety of soft tissue wounds including dorsal hand wounds. We document the number, emerging diameter, length from origin, course, and location of all perforators of the radial artery in a series of 6 fresh human cadavers after whole body lead oxide and gelatin injection to confirm and comprehensively document the anatomy of the radial artery perforators. This data provide an anatomic basis for a modification to the reversed radial forearm flap used to decrease venous congestion in the postoperative period. Two case reports are presented to provide clinical demonstration of the importance of this modification.

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Section: Discussionmentioning

confidence: 98%

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications

White

Steve

Buchel

et al. 2016

Annals of Plastic Surgery

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“…Early published series demonstrated donor radius fracture rates ranging up to 67%. 6 In 1999, Thoma et al reported a 15% fracture incidence in 60 consecutive patients over a 11-year period. 15 Many of these arms were prophylactically immobilized, and fractures were treated with a variety of methods ranging from prolonged immobilization to vascularized bone graft reconstructions.…”

Section: Discussionmentioning

confidence: 99%

“…Two issues have been largely to blame for limiting surgeons' consideration of the OCRFFF as an option for single-stage reconstruction of composite defects in the head and neck: the inadequacy of available bone and the potential for morbidity, most notably pathological fracture. 6,7 INDICATIONS AND CONTRAINDICATIONS We describe a modified harvest technique for the OCRFFF that employs prophylactic internal fixation of the donor radius. The evolution of this technique has resulted in a safe OCRFFF harvest, with donor site morbidity similar to that observed with the widely used RFFF.…”

mentioning

confidence: 99%

Safe Osteocutaneous Radial Forearm Flap Harvest with Prophylactic Internal Fixation

Shnayder

Tsue

Toby

et al. 2011

Craniomaxillofacial Trauma & Reconstruction

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We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest by the University of Kansas Head and Neck Microvascular Reconstruction Team. Mean follow-up was 13 months. One of two patients undergoing OCRFFF harvest without prophylactic fixation developed a pathological radius fracture. The 68 subsequent OCRFFF patients underwent prophylactic fixation of the donor radius, and none developed a symptomatic radius fracture. Five of 68 patients did have a radiographically visible fracture requiring no intervention. The plate fixation technique was further modified to exclude monocortical screws in the radius bone donor defect (subsequent 39 patients), without any further fractures detected. One patient required forearm hardware removal for an attritional extensor tendon tear. The described modified OCRFFF harvest and prophylactic plate fixation technique may eliminate postoperative pathological fracture of the donor radius. Donor morbidity is similar to that of the fasciocutaneous radial forearm free flap , affording safe use of OCRFFF in head and neck reconstruction.

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“…[1][2][3][4][5][6] Its use historically has been limited by the purportedly high rate of donor radius fracture. Matthews et al 7 in 1983 reported a rate of 67 percent when two of three of their initial radial osteocutaneous free flaps had donor radius fractures after resection of 50 percent of the diameter of the radius through perpendicular osteotomies. Donor radius fracture is considered the greatest disadvantage of the flap, as several studies have reported severe functional impairment after fracture.…”

mentioning

confidence: 99%

Should the Donor Radius be Plated Prophylactically after Harvest of a Radial Osteocutaneous Flap? A Cost-Effectiveness Analysis

Rockwell¹,

Thoma²

2004

J reconstr Microsurg

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The objective of this study was to assess the cost-effectiveness of prophylactic plating of the donor radius after harvest of a radial osteocutaneous flap. Costs were measured from a Ministry of Health perspective, and effectiveness in terms of quality adjusted life years (QALYs.) A literature search identified 22 studies reporting complications of radial osteocutaneous free flaps, and nine studies reporting complications of radius plating. The rates of the various complications were pooled to provide the probability of each clinically important complication. A decision analytic model was used to determine the total costs, and QALYs for each of the treatment options. The expected direct costs for prophylactic plating and treatment after fracture were $2071 and $140, respectively. The expected QALYs for prophylactic plating and treatment after fracture were 8.55 and 9.92, respectively. It was concluded that prophylactic plating of the donor radius is not a cost-effective approach when compared to the treatment of donor radius fractures after they occur.

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Experience with the Radial Forearm Flap in 14 Cases

Cited by 21 publications

References 10 publications

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications

Safe Osteocutaneous Radial Forearm Flap Harvest with Prophylactic Internal Fixation

Should the Donor Radius be Plated Prophylactically after Harvest of a Radial Osteocutaneous Flap? A Cost-Effectiveness Analysis

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