Application of Radial Forearm Free Flap for Extraoral Head and Neck Soft Tissue Reconstruction J. Jeremic, Z. Nicolic, L. Drcic, A. Petrovic, K. Jeremic
Voinosanitetski Pregled (Military-Sanitary Review) 2009: 66(4): 1–5
The authors presented their experience with reconstruction of extraoral, head and neck defects with free radial forearm flaps (RFF) for the period from 2001-2007. During this period, there were a total of 19 patients (20 RFF) treated at the Clinic for Maxillofacial Surgery, Faculty of Dentistry and the Center for Burns, Plastic and Reconstructive Surgery in Belgrade, Serbia. There were 15 male and 5 female patients, their ages ranged from 38-67 years. The diagnoses of the treated lesions were basal-cell carcinoma in 18 patients, one sebaceous-cell carcinoma and one dermato-fibrosarcoma. Five of the lesions were located on the neck, 2 in the following regions: orbito-zygomatic, fronto-parietal, zygomatico-temporal, parieto-occipital and parotid-masseter. The following regions had 1 lesion each: fronto-temporal, temporo-parieto-occipital, facial, temporal and orbital. The size of the surgical defects after ablation ranged from 6 cm x 7 cm to 17 cm x 14 cm. The anastomotic vessels were the superior thyroid artery in 12 cases and facial artery in 8 cases. The drainage vessels were internal jugular vein in 8 patients, external jugular vein in 7 cases and facial vein in 5 patients. The length of the radial vessels ranged from 5 to 11 cm (average 6.5 cm). There was one case of complete flap failure due to venous anastomosis failure within 48 hours post-operatively. The flap was re-explored and the anastomoses revised but the flap still failed. This patient was reconstructed with a second RFF anastomosed to the contralateral superior thyroid artery and internal jugular vein. The second flap was a success. Another patient had skin stasis demarcation at the distal edge of the flap, which was self-contained within 24 hours. This complication occurred in a diabetic patient. The distal skin edge was debrided and covered with free skin graft. Regarding the donor site complications, there was one split-thickness flap failure, which required secondary coverage with a second free skin graft. The overall flap survival of RFF was 89.5%. The authors concluded that RFF was a primary choice for reconstruction of defects in the head and neck since it provided thin, pliable tissues and a long vascular pedicle.