The Clinical Evaluation of The Reconstruction of Radial Forearm Free Flap in the Head and Neck Cancer Surgery

두경부 악성 종양 절제술후 요골 전완 유리피판을 이용한 재건술의 평가

  • Kim Hyun-Jik (Department of Otorhinolaryngology, Yonsei University College of Medicine) ;
  • Lim Young-Chang (Department of Otorhinolaryngology, Yonsei University College of Medicine) ;
  • Song Mee-Hyun (Department of Otorhinolaryngology, Yonsei University College of Medicine) ;
  • Lee Won-Jae (Department of Plastic Surgery, Yonsei University College of Medicine) ;
  • Choi Eun-Chang (Department of Otorhinolaryngology, Yonsei University College of Medicine)
  • 김현직 (연세대학교 의과대학 이비인후과학교실) ;
  • 임영창 (연세대학교 의과대학 이비인후과학교실) ;
  • 송미현 (연세대학교 의과대학 이비인후과학교실) ;
  • 이원재 (연세대학교 의과대학 성형외과학교실) ;
  • 최은창 (연세대학교 의과대학 이비인후과학교실)
  • Published : 2003.11.01

Abstract

Background and Objectives: The reconstruction is very important in Head and neck cancer surgery to repair the defect created by resection of tumors, to enable successful wound healing, to restore function and to provide acceptable cosmesis. The radial forearm free flap has been the most useful reconstructive flap because it provides a moderate amount of thin, pliable, relatively hairless skin and comparatively simple to do with minimal morbidity. The aims of this study is to estimate the outcome of the reconstruction with radial forearm free flap with the several factors in 140 head and neck cancer cases in our hospital for last 10 years. Materials and Methods: Retrospective review of the records of 140 patients underwent resection of the head and neck tumors and reconstruction with a radial forearm free flap from 1993 to 2003. The age, sex of the patients, Primary site, the complication of donor and recipient site, flap survival rate, median time to start diet, patient subjective symtoms about swallowing and articulating and the fact of revision reconstructive surgery were analyzed. Results: In primary pathologic site, 56 cases were oral cavity cancers, 44 cases, oropharyngeal cancers and 22 cases, hypopharyngeal cancers. Flap survival rate was 93.6% (13 leases). On donor site, wound dehiscence, hematoma, sensory change and infection were noted and on recipient site, most common complication were fistula and wound dehiscence. The complication rate of recipient's site was 19.1 % and donor site, 3.5%. In 118 cases (84.3%), the patients could take all kinds of food. Swallowing difficulty were noted in 22 cases 05.7%). In 5 cases, there was articulation difficulty but most of patients except patients having total laryngectomy (18 cases) couldn't have any difficulty in articulation and speaking. Conclusion: We conclude that the radial forearm free flap is the most appropriate reconstructive material for treating the defect in head and neck reconstruction.

Keywords

References

  1. Salibian AH, Allison GR, Krugman ME, et al : Reconstruction of the base of tongue with the microvascular ulnar forearm flap :functional assessment. Plastic Reconstr Surg. 1995 ; 96 : 1081-1089 https://doi.org/10.1097/00006534-199510000-00011
  2. McConnel FMS, Logemann JA, Rademaker AW : Surgical variables affecting post-operative swallowing efficiency in oral cancer patients: pilot study. Laryngoscope. 1994 ; 104 : 87-90
  3. Langdon JD, Patel MF : Operative Maxillofacial Surgery. London : Chapman and Hall, 1998 : 117
  4. Shah JP, Hanibhakti V, Lore TR, Sutaria P : Complication of pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg. 1990 ; 160 : 352-355 https://doi.org/10.1016/S0002-9610(05)80541-0
  5. Panchal AI, Potterton J, Scanlon E, Mclean NR : An objective assessment of speech and swallowing following free flap re-construction for oral cavity cancers. Br J Plast Surg. 1996 ; 49: 363
  6. Kroll SS, Reece GP, Miller MJ, Schusterman MA : Comparison of the rectus abdominis free flap with the pectoralis major myocutaneous flap for reconstructions in the head and neck. Am J Surg. 1992 ; 164 : 615-618 https://doi.org/10.1016/S0002-9610(05)80719-6
  7. Schusterman MA, Kroll SS, Weber RS, Byers RM : Intraoral soft tissue reconstruction after cancer ablation : A comparison of the pectoralis major flap and the free radial forearm flap. Am J Surg. 1991 ; 162 : 397-399 https://doi.org/10.1016/0002-9610(91)90157-9
  8. Sullivan MJ : Head and neck reconstruciton by free tissue transfer. In : Cummings SW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, editors Otolaryngology-Head and Neck Surgery. 2nd ed. St Louis: Mosby Year Book, 1993 : 181-189
  9. Jeng SF, Kuo YR, Wei FC, et al : Free Radial Forearm Flap with Adipofascial tissure extension for Reconstruction of Oral cancer defect. Ann Plast Surg. 2002 ; 49 : 151-155 https://doi.org/10.1097/00000637-200208000-00007
  10. Hwang EA, Lew DH, Kim YS, et al : Design of Radial Forearm Free Flap for Oropharyngeal Reconstruction J Korean Soc Plast Reconstr Sur. 2000 ; 27 : 539-544
  11. Soutar DS, Scheker LR, Tanner NSB, McGregor IA : The radial forearm free flap : a versatile methodfor intraoral reconstruction. Br J Plast Surg. 1983 ; 36 : 1
  12. Smith Gl, Brennan PA, Scott PJ, Ilankovan V : Outcome after redial forearm, gastro-omental, and jejunal free flaps in oral and oropharyngeal reconstruction. British Journal of Oral and Maxillofacial Surgery. 2002 ; 40 : 330-333 https://doi.org/10.1016/S0266-4356(02)00132-8
  13. Andre Eckardt, Konstantinos Fokas : Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. Journal of Cranio-Maxillofacial Surgery. 2003 ; 31 : 197-201 https://doi.org/10.1016/S1010-5182(03)00039-8
  14. Hidalgo DA, Disa JJ, CordeiroPG, Hu QY : A review of 716 consecutive free flaps for oncological surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg. 1998 ; 102 : 722-732 https://doi.org/10.1097/00006534-199809030-00016
  15. O'Brein CJ, Lee KK, Stem HS, et al : Evaluation of 250 free flap reconstruction after resection of tumors of head and neck. Aust NZ J Surg. 1998 ; 68 : 698-701 https://doi.org/10.1111/j.1445-2197.1998.tb04654.x
  16. Jones NF, Johnson IT, Shestak KC, et al : Microsurgical reconstruction of the head and neck : interdisciplinary collaboration between head and neck surgeons in 305 cases. Ann Plast Surg. 1996 ; 36 : 37-43 https://doi.org/10.1097/00000637-199601000-00008
  17. Singh B, Cordeiro PG, Santamaria E, et al ; Factors associated with complications in microvascular reconstruciton of head and neck defects. Plast Reconst Surg. 1999 ; 103 : 403-411
  18. Urken ML, Weinberg H, Buchbinder D, et al : Microvascular free flap in head and neck reconstruction-report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg. 1994 ; 120 : 633-40 https://doi.org/10.1001/archotol.1994.01880300047007
  19. Vaughan ED : The radial forearm flap in orofacial reconstruction. Personal experience in 120 consecutive cases. J Crani-Maxillofacial Surg. 1990 ; 18 : 2-7 https://doi.org/10.1016/S1010-5182(05)80596-7
  20. Richardson D, Fischer SE, Vaughan ED, Brown JS ; Radial forearm flap donor-site complication and morbidity: Prospective study. Plast Reconstr Surg. 1997 ; 99 : 109-115 https://doi.org/10.1097/00006534-199701000-00017
  21. Su WF, Hsia YJ, Chang YC, et al : Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue. 2003 ; 128 : 412 -418
  22. Joseph Scharpf, Ramon M, Esclamado : Reconstruction with radial forearm free flaps after ablative surgery for hyporpharyngeal cancer. Head and Neck. 2003 ; 25 : 261-266 https://doi.org/10.1002/hed.10197
  23. Hadi Seikaly, Jana Riefer, John Wolfaardt, et al : Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap. Laryngoscope. 2003 ; 897-904