Reconstruction of the Naso‐orbital‐ethmoid (NOE) Complex Using the Osteocutaneous Radial Forearm Flap (OCRFF)

Abstract

Osteocutaneous radial forearm flap (OCRFF) is a cosmetically acceptable method of reconstructing NOE defects. Though a 1-step reconstruction can be serviceable without multiple additional procedures, longer surviving patients frequently receive revision surgery as with more traditional planned staged procedures.

Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction

“…In our series, our complications were similar to what is expected and reported in the postoperative course of complex reconstruction in the head and neck . Notable recipient site morbidity in the immediate perioperative period included 2 intraoral dehiscences of palatomaxillary reconstructions.…”

“…The rigid yet low profile bone offered by the osteocutaneous RFFF allows for increased versatility and malleability in areas of complex recipient site architecture. For example, the bone in the osteocutaneous RFFF is well suited for reconstruction of the orbital rim, nasal bridge, nasoorbitoethmoid complex, anterior maxilla, and the cricotracheal area . The osseous component of other flaps may be too bulky for these reconstructions.…”

“…In addition, the nature of bone still allows for a limited number of osteotomies. Although some have performed many osteotomies on the bone, we limit the number of osteotomies to one . As seen in Al‐Khudari et al, the bone can be thinned to fit into delicate areas, such as a partial tracheal defect after tumor resection, or contrarily, can be “double‐barreled” to provide thicker bone stock to allow for dental implants in maxillectomy reconstruction …”

“…For example, the bone in the osteocutaneous RFFF is well suited for reconstruction of the orbital rim, nasal bridge, nasoorbitoethmoid complex, anterior maxilla, and the cricotracheal area. [16][17][18] The osseous component of other flaps may be too bulky for these reconstructions. In addition, the nature of bone still allows for a limited number of osteotomies.…”

“…Although some have performed many osteotomies on the bone, we limit the number of osteotomies to one. 18,19 As seen in Al-Khudari et al, 16 the bone can be thinned to fit into delicate areas, such as a partial tracheal defect after tumor resection, or contrarily, can be "double-barreled" to provide thicker bone stock to allow for dental implants in maxillectomy reconstruction. 19 Furthermore, the osteocutaneous RFFF provides a thin and pliable skin paddle that is not available with other osteocutaneous flaps.…”