Osteocutaneous radial forearm free flap: Its use without significant donor site morbidity

Abstract

While the fasciocutaneous radial forearm free flap has gained increasing popularity, the osteocutaneous radial forearm free flap has been condemned because of a high rate of pathologic donor radius fracture. On the basis of studies that demonstrated increased strength in ostectomized radii after dynamic compression plating, we believed that internal fixation at the time of graft harvest would significantly reduce the incidence of donor radius fracture. This is a retrospective review of the first 54 patients undergoing osteocutaneous radial forearm free flap reconstruction of the head and neck at our institution; 52 underwent prophylactic plating of their donor radii. No clinically significant donor radius fractures have occurred in plated patients. Five asymptomatic fractures were discovered on routine radiographs and required no treatment. Objective evaluation of forearm range of motion and strength after graft harvest demonstrated excellent function compared with unoperated arms. Serial radiographs have shown remodeling and reconstitution of donor radii without localized osteopenia.

The use of the Radial Styloid in the Extended Osteocutaneous Radial Forearm Free Flap

“…Further refinements in the setting of PIF include using a low-contact dynamic compression plate (25), excluding screws from the osteotomized portion of the radius (25) and adding bone graft to the donor radius (11). The rate of fracture when all patients undergo PIF was 0.5% in two large retrospective reviews (3,9), and 0% (25,26) to 9.6% in smaller similar series (5,27). Routine PIF appears to have reduced the fracture risk associated with the OC-RFFF, even in the setting of large bone flaps (harvest of 40% to 50% of the radius circumference) (3,7,25).…”

“…It adds time, complexity and cost to a procedure, which inherently consume a great deal of resources and this may not be cost effective (30). However, when a fracture occurs with fixation in place, treatment is less difficult because the fractures tend not to displace (4,5,10,27). Taking this information into consideration, there should be a low threshold to perform PIF in patients undergoing an OC-RFFF.…”

Reconstruction of a Recurrent First Dorsal Web Space Defect Using Acellular Dermis

“…[6,10] The functional outcome of such defects is predicated on the use of durable and pliable tissue for reconstruction [7,17,37]. These criteria can be difficult to achieve for larger defects, where local skin flaps are of limited use, and pedicled forearm flaps can provide excess tissue bulk [3,27,35,38,47].…”

“…For example, in anatomic zones of high functionality, skin grafts can be deleterious as a result of contracture. In addition, for larger defects, local flaps may be inadequate, and pedicled flaps may impart excess bulk within the area [3,27,35,38,47].…”

Microvascular Free Flaps in Oral and Maxillofacial Reconstruction following Cancer Ablation

“…It is versatile in that it also may be transferred as a sensory flap incorporating the medial or lateral antebrachial cutaneous nerve, 8,9 or a composite bone flap using vascularized radius. [10][11][12] It also may include vascularized tendon 13 and brachioradialis muscle. 14 The major disadvantages of RFFF is the donor site morbidity especially in cases of paratendon damage during flap harvest causing tenting and painful donor site which can be reduced by suprafascial dissection and minimizing paratenton exposure.…”