The radial forearm free flap: a review of microsurgical options

Chardon, V. Médard de; Balaguer, Thierry; Chignon-Sicard, Bérengère; Riah, Y.; Ihraï, T.; Dannan, Emad; Lebreton, E.

doi:10.1016/j.bjps.2008.06.053

Cited by 38 publications

(22 citation statements)

References 71 publications

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“…Many articles have already documented that radiotherapy is not a contraindication for microsurgical free flap transfer, though it remains controversial. 1 However, this study proves the value of the SF-RFF for selective cases in which there is a need for vein grafts or contralateral neck dissection, or in which there are compromised recipient vessels.…”

Section: Discussionmentioning

confidence: 90%

“…Moreover, as the introduction of adjuvant chemoradiation for head and neck cancer, these vessels may be present but damaged with intimal fibrosis and arteriosclerosis, 6,29 even if the role of radiotherapy in flap failure is still under debate. 1 In these cases, several options have been described. The use of contralateral vessels is possible, but requires extensive dissection, flaps with long pedicles, or vein grafts.…”

Section: Discussionmentioning

confidence: 98%

“…Although a success rate of 95% has been reported, RFFF necrosis occurs even with the most experienced surgical teams. 1 Venous thrombosis is mainly responsible for necrosis, 8,10,11 leading to delayed surgical revision. Salvage rates range from 3 to 12% after venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 But no consensus has been reached on either the choice of the venous system for anastomosis or the number of anastomoses that should be performed. 1 To prevent venous thrombosis, many studies focused on the choice of the recipient vein. In head and neck reconstruction, the venous anastomosis can be performed on either the external jugular vein or internal jugular vein (IJV) and its branches.…”

Section: Discussionmentioning

confidence: 99%

“…The RFFF is a reliable flap, with a success rate greater than 95% reported in the most recent studies. [1][2][3][4][5][6] Failures are mainly due to venous thrombosis, [7][8][9] especially in patients with prior radical neck dissection or radiotherapy, 10 and such failures are often diagnosed late leading to flap loss. 2 To prevent this complication, a semi-free radial forearm flap (SF-RFF) can be performed with the dissection of the cephalic vein up to the deltopectoral crease and without any venous anastomosis.…”

Section: Patients and Methodmentioning

confidence: 99%

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Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

et al. 2012

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patients and Methodmentioning

confidence: 99%

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Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

et al. 2012

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Shape‐modified radial forearm free tissue transfer in oral cavity reconstruction: Technique and a prospective comparison with the conventional technique

et al. 2020

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Background: Donor site morbidity is a significant drawback of the radial forearm flap. The purpose of this study is to describe a new shape-modified technique. The donor site morbidity was compared to that of the conventional technique, in terms of the esthetic, functional outcomes, and quality of life (QOL). Methods: This is a prospective study of 30 patients with oral cancer who underwent reconstruction using radial forearm flaps, in two groups. Results: Regarding the donor site characteristics, the differences in the time for healing (P = .006), the scar score (P < .0001), and the QOL score (P < .0001) were significant. The number of patients with sensory deficit was 11 in the conventional group and 3 in the shape-modified group (P = .009). Conclusions: The functional and esthetic outcomes of the donor site were better for the shape-modified technique. It is best suited for small defects. Compromise of the pedicle length is a limitation.

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The venae comitantes clipping test for the evaluation of the venous drainage of the radial forearm free flap

2015

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Risks of failure of the radial forearm free flap (FRFF) are mainly related to venous congestion. Two different venous drainage system have been described for the FRFF, but the choice of the best one is still controversial. The superficial systems have a larger diameter and a thicker wall veins which makes them easier to anastomose. The deep system provides most part of the venous outflow if the caliber of the venae comitantes (VCs) is adequate. We propose an intra-operative method to evaluate the FRFF venous drainage: the VCs clipping test. The test has been used in the choice of the vein to anastomose in 12 consecutive patients with oral cavity post oncological defects reconstructed with the FRFF. The cephalic vein was included in the flap; the VCs were individually clipped with small liga-clips and divided with the radial artery still patent. The flap was kept with arterial inflow and superficial venous outflow till the recipient site was ready. If there were no signs of venous stasis, the VCs were kept clipped and the cephalic vein anastomosis was made. If clinical signs of venous stasis were revealed, the largest of the VCs was anastomosed to a vein of adequate caliber in the neck. No signs of flap venous congestion were observed in the postoperative period. No flap necrosis occurred. In this small series of patients the venae comitantes clipping test showed to be an easy, reliable and reproducible method to assess intra-operatively which vein to anastomose. © 2015 Wiley Periodicals, Inc. Microsurgery 36:647-650, 2016.

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The radial forearm free flap: a review of microsurgical options

Cited by 38 publications

References 71 publications

Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

Shape‐modified radial forearm free tissue transfer in oral cavity reconstruction: Technique and a prospective comparison with the conventional technique

The venae comitantes clipping test for the evaluation of the venous drainage of the radial forearm free flap

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