Role of ulnar forearm free flap in oromandibular reconstruction

Abstract

The ulnar forearm flap is not frequently utilized for oromandibular reconstruction. This study evaluated the usefulness of the ulnar free flap for reconstruction. A retrospective study of 32 patients was conducted. The ulnar forearm flap was combined with an osseous flap in 24 patients. Nine females and 23 males with a mean age of 58.15 years comprised our study population. Squamous-cell carcinoma was the diagnosis in 93.75% of cases (56.25% T4), of which 20% were recurrent. Functional evaluation of swallowing was based on the University of Washington Questionnaire (UWQ). The mean hospital stay was 9.8 days. The external carotid (100%) was the recipient artery, and the internal jugular (74.07%) was the main recipient vein. Overall flap survival was 96.8%. One flap was lost due to unsalvageable venous thrombosis. Major local complications were seen in 9.4% of cases and included partial flap loss, hematoma, and an orocutaneous fistula. At the time of this study, 21 patients were available for functional evaluation. Speech was rated excellent and good in 33.3% of patients. Swallowing was found good in 28.6% of patients. Chewing was rated excellent and good in 47.6% of patients. Cosmetic acceptance was rated good in 71.4% of cases. The ulnar forearm is a useful free flap in oromandibular reconstruction. It is available when the radial artery is the dominant artery of the hand. Being more hidden, it may be more cosmetically accepted. It affords pliable soft tissue for lining and/or covering of oromandibular defects, and can be used as a second choice after other free-flap failures.

Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self‐controlled study

“…This explanation was also supported by some studies reporting that UFF is superior to the RFF in terms of cosmesis. 14,18,21,22,26 The strength of the current study is comparing pre and postoperative objective data of the same hand to reveal the actual status of the donor site. However, some limitations of this study have to be mentioned, including the small sample size and the relatively short follow-up period.…”

Ulnar forearm free flaps in head and neck reconstruction: Systematic review of the literature and a case report

“…The UFFF is a unique free flap for use in the head and neck. The flap includes the ulnar artery distal to its common interosseous branch, with or without the flexor carpi ulnaris muscle, palmaris longus tendon, medial cutaneous nerve, and bone as needed . Prior to surgery, an Allen's test is almost universally performed to determine radial or ulnar artery dominance in the hand.…”

“…The flap includes the ulnar artery distal to its common interosseous branch, with or without the flexor carpi ulnaris muscle, palmaris longus tendon, medial cutaneous nerve, and bone as needed. 3,10,30 Prior to surgery, an Allen's test is almost universally performed to determine radial or ulnar artery dominance in the hand. The UFFF is often employed when an Allen's test/modified Allen's test is positive, indicating the blood flow to the hand is radial-dominant with insufficient collateral flow through the ulnar artery to adequate perfuse the hand.…”

“…Sixty-three articles were excluded either due to lack of relevance or publication in a language other than English. In addition to our case presentation, 681 cases of UFFF were identified in the selected publications [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Fifty-five percent (372 of 682) of the cases reported use of the Allen's test, with one study noting that in 23 of the 30 cases, a UFFF was specifically selected over a RFFF due to a positive Allen's test.…”

Anatomical basis and clinical application of the ulnar forearm free flap for head and neck reconstruction

“…Since its introduction, the ulnar forearm flap has been used in tongue, oromandibular, extremity, and penile reconstructive surgeries 10–14. Rodriguez et al prospectively studied hand function following ulnar forearm flap‐harvesting, and reported comparable results between the hands with and without operation in terms of two‐point discrimination, grip strength, and digital perfusion, despite a mean increase in the radial blood flow of 17.5% following ulnar artery sacrifice 15.…”