Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts

Abstract

Free flap transfer for reconstruction of intraoral defects is a common procedure in oral and maxillofacial surgery. For tumor-related defects, the radial forearm flap is widely used for soft tissue restoration. However, transfer of free skin grafts to the donor site region is often required for wound closure after free flap harvesting, resulting in esthetic disturbances due to shrinkage of the grafted skin, attendant scarring, or mismatches in skin texture or color. Furthermore, free flap transfer may result in hair follicle transfer into the oral cavity, causing unfavorable intraoral hair growth in adult men in particular. Free flap prelamination can help reduce the potential disadvantages of free flaps, in terms of both flap design and size and donor site morbidity. For surgical treatment of oral cancer in middle-aged and elderly patients, eyelid dermatochalasis may present as a comorbidity leading to esthetic impairments or, in cases involving the upper eyelid, even a reduced field of view. In these cases, bilateral blepharoplasty can reduce the excess eyelid skin. The present study is the first to attempt to use excised skin after bilateral blepharoplasty as full-thickness skin grafts for radial forearm free flap prelamination. This approach combined surgical therapy of eyelid dermatochalasis with free flap prelamination, thereby avoiding the need to harvest free skin grafts from other anatomically healthy regions to close the donor site defect and preventing the accompanying disadvantages. The reconstruction results and clinical outcomes of patients revealed that radial forearm free flap prelamination using bilateral free full-thickness eyelid skin grafts was an easy and feasible method for intraoral defect reconstruction. In particular, this approach could avoid intraoral hair growth and additional skin grafting from other healthy anatomical regions, yielding good esthetic and functional results at the flap's recipient and donor sites.

Aesthetic and Functional Reconstruction of Periorbital Region Using Radial Forearm Free Flap

“…The reconstructive approach is determined by the defect's extent, with local flaps serving well in limited defects [4][5][6] ; however, extensive, full-thickness deficiencies often necessitate more intricate procedures, such as free tissue transfer. [7][8][9][10][11][12][13] The radial forearm free flap (RFFF) is a well-established method for reconstructing considerable defects in the head and neck region, particularly when thin and pliable tissue is required. The flap's pedicle length is pivotal, with the radial forearm offering the necessary length for microvascular anastomosis.…”

Effect of comfort nursing in the perioperative period of free flap transplantation to repair the defects after surgery for malignant head and neck tumors

“…Free flaps exhibit good compatibility with head and neck defects, ensuring good functional and aesthetic outcomes. [5][6][7] Several studies have reported that free flap transplantation in patients with head and neck tumors can improve skin defects, thereby enhancing skin functionality and appearance, and having considerable therapeutic value. [5,[8][9][10] However, free flap surgeries are associated with multiple perioperative complications; therefore diligent perioperative care is crucial for the success of the procedure.…”