Outcomes of the Osteocutaneous Radial Forearm Free Flap for Mandibular Reconstruction

Abstract

This is the largest single study reporting outcomes and complications for patients undergoing OCRFFF for mandibular reconstruction. Prophylactic plating of the donor radius has nearly eliminated the risk of pathologic radial bone fractures. Limited long-term donor and recipient site complications support the use of this flap for single-stage mandibular reconstruction.

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

“…The rates of recipient site infection, bone or plate fracture, malunion/nonunion were found to be very low (1% to 3% each) (3). Donor site complications were similarly low, including a single radius fracture in each series (incidence 0.45% to 0.6%) (3,9). Notably, recipient site hardware exposure was 16% to 17%, a value that is higher than typically reported for the fibula flap (16,17), but consistently reported for the OC-RFFF (9,15).…”

“…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).…”

“…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). Because this is a new modification, there are no data regarding the effect of including the border of the radial styloid on fracture risk, although we suspect it will not affect the fracture rate because invariably, the fracture occurs proximally where the radius is the narrowest.…”

“…The fracture risk without PIF is not 100% (19,21,22) and prophylactic plating has not eliminated fractures (3,10). Studies have indicated that harvesting bone from the radius significantly impacts the strength of the bone (23,24).…”

“…Our technique facilitates a longer bone flap and, therefore, could theoretically increase the risk for a pathological fracture; however, the length is added distally, where fractures do not occur. To date, there is insufficient evidence to determine the exact risk associated with the length of radius harvested, and long bone segments (up to 12 cm) are being routinely harvested by other surgeons (3,5,25).…”