Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors

Orlík, J; Horwich, Peter; Bartlett, Clark; Trites, Jonathan; Hart, Robert D.; Taylor, S. Mark

doi:10.1186/1916-0216-43-1

Cited by 72 publications

(52 citation statements)

References 25 publications

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“…NAC has been shown to interfere with biofilm formation of Staphylococcus epidermis 25 . Subsequently, NAC has been shown to inhibit the growth of many different bacteria, including P. aeruginosa 26–29 . It is known that a low concentration of acetate with pH corresponding to 6 leads to a bacteriostatic effect, but higher concentration of undissociated acid is needed for cell killing 30 .…”

Section: Introductionmentioning

confidence: 99%

Mechanistic action of weak acid drugs on biofilms

Kundukad

Schussman

Yang

et al. 2017

Sci Rep

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Selective permeability of a biofilm matrix to some drugs has resulted in the development of drug tolerant bacteria. Here we studied the efficacy of a weak organic acid drug, N-acetyl-L-cysteine (NAC), on the eradication of biofilms formed by the mucoid strain of Pseudomonas aeruginosa and investigated the commonality of this drug with that of acetic acid. We showed that NAC and acetic acid at pH < pKa can penetrate the matrix and eventually kill 100% of the bacteria embedded in the biofilm. Once the bacteria are killed, the microcolonies swell in size and passively shed bacteria, suggesting that the bacteria act as crosslinkers within the extracellular matrix. Despite shedding of the bacteria, the remnant matrix remains intact and behaves as a pH-responsive hydrogel. These studies not only have implications for drug design but also offer a route to generate robust soft matter materials.

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Section: Introductionmentioning

confidence: 99%

Mechanistic action of weak acid drugs on biofilms

Kundukad

Schussman

Yang

et al. 2017

Sci Rep

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“…This procedure can affect the sensation and motor function of the hand, and the concealment of the surgical wound is not ideal. Second, grafts are needed to block the donor area, and the scar is so apparent that it is difficult for many people to accept [22,23]. In this study, only 9 (42.9%) patients were satisfied with the donor area postoperatively, which was the lowest level of satisfaction of any group (ALT, 50%; LAF and DIEP, 100%) ( Fig.…”

Section: Discussionmentioning

confidence: 71%

Comparative analysis of the functional results of tongue reconstruction with four kinds of free flaps after radical resection of tongue cancer

Cai

Zeng

et al. 2020

Preprint

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BackgroundSurgery is still the treatment of choice for tongue cancer. Tongue reconstruction should be performed immediately after extensive resection of the tumor, which will affect the patient's function. The purpose of this study was to investigate the functional evaluation of four different free flaps in tongue reconstruction after a tongue cancer operation. Methods Forty-eight cases of tongue reconstruction with a radial forearm free(RFF flap), anterolateral thigh(ALT) flap, lateral upper arm free(LAF)flap and deep inferior epigastric artery perforator(DIEP)flap from 2014 to 2018 were analyzed. The speech function, swallowing function, tongue flexibility and patients' satisfaction with the donor area was investigated six months after repair. ResultsTwenty-one cases with RFF flaps, 18 cases with ALT flaps, 5 cases with LAF flaps and 4 cases with DIEP flaps showed complete flap survival. Speech function:39.6% of the patients exhibited normal speech, 43.8% of the patients exhibited near-normal speech, the RFF flap group was showed better recovery than did the other three groups ( p =0. 195). The degree of tongue flexibility: 37.5% of the patients with normal postoperative tongue flexibility, 43.6% of the patients with slightly limited tongue flexibility,, 16.7% of the patients with severely limited tongue flexibility, The flexibility of the RFF flap was better than that of the other three groups( p =0. 054). Swallowing function:47.9% of the patients had a regular diet, 33.3% of the patients had soft foods, 16.7% patients receive fluid diet, The RFF flap group showed better recovery than did the other three groups ( p =0. 248). Donor satisfaction: 56.2% of the patients were satisfied, 41.7% of the patients were basically satisfied, 100% of the patients with LAF and DIEP flaps were satisfied. This level of satisfaction was better than that in the RFF and ALT flap groups. ( p =0. 039). ConclusionThe functional recovery of RFF flap in tongue reconstruction after middle and early stage tongue cancer surgery is better. However, ALT flap has been used more frequently for a large number of

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“…14 There have been several previous groups who have investigated the functional outcomes of RFFF donor sites and found decreased strength with wrist flexion and pinch compared with both contralateral extremities and control groups not undergoing RFFF reconstruction. [15][16][17][18][19][20][21] Still, none of these investigators focused on undesirable outcomes related to the sensory nerves of the hand and forearm, although conceivably, weakness in pinch and/or grip strength might have been related to pain.…”

Section: Discussionmentioning

confidence: 99%

An Algorithm for the Prevention and Treatment of Pain Complications of the Radial Forearm Free Flap Donor Site

Calotta

Chandawarkar

Desai

et al. 2020

J Reconstr Microsurg

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Background The radial forearm free flap (RFFF) is a staple of microsurgical reconstruction. Significant attention has been paid to donor-site morbidity, particularly vascular and aesthetic consequences. Relatively few authors have discussed peripheral nerve morbidity such as persistent hypoesthesia, hyperesthesia, or allodynia in the hand and wrist or neuroma formation in the wrist and forearm. Here, we present a diagnostic and therapeutic algorithm for painful neurologic complications of the RFFF donor site. Materials and Methods The peripheral nerves that can be involved with the RFFF are reviewed with respect to the manner in which they may be involved in postoperative pain manifestations. A method for prevention and for treatment of each of these possibilities is also presented. Results Nerves from the forearm that can be harvested with the RFFF will have the most likelihood for injury and these include the lateral antebrachial cutaneous nerve, the radial sensory nerve, and the medial antebrachial cutaneous nerve. A nerve that may be injured at the distal juncture of the skin graft to the forearm is the palmar cutaneous branch of the median nerve. The “prevention” portion of the algorithm suggests that each nerve divided to become a recipient nerve should have its proximal end implanted into a muscle to prevent painful neuroma. The “treatment” portion of the algorithm suggests that if a neuroma does form, it should be resected, not neurolysed, and the proximal portion should be implanted into an adjacent muscle. The diagnostic role of nerve block is emphasized. Conclusion Neurological complications following RFFF can be prevented by an appropriate algorithm as described by devoting attention to the proximal end of recipient nerves. Neurological complications, once present, can be difficult to diagnose accurately. Nerve blocks are critical in this regard and are employed in the treatment algorithm presented.

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Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors

Cited by 72 publications

References 25 publications

Mechanistic action of weak acid drugs on biofilms

Mechanistic action of weak acid drugs on biofilms

Comparative analysis of the functional results of tongue reconstruction with four kinds of free flaps after radical resection of tongue cancer

An Algorithm for the Prevention and Treatment of Pain Complications of the Radial Forearm Free Flap Donor Site

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