Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap

  • Received : 2018.01.30
  • Accepted : 2018.05.27
  • Published : 2018.07.15
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Abstract

Background The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site. Methods We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively. Results A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss. Conclusions For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.

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References

  1. Yang GF, Chen PJ, Gao YZ, et al. Forearm free skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg 1997;50:162-5. https://doi.org/10.1016/S0007-1226(97)91363-1
  2. Urken ML, Weinberg H, Vickery C, et al. The combined sensate radical forearm and iliac crest free flaps for recon- struction of significant glossectomy-mandibulectomy de- fects. Laryngoscope 1992;102:543-58. https://doi.org/10.1288/00005537-199205000-00014
  3. Swanson E, Boyd JB, Manktelow RT. The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients. Plast Reconstr Surg 1990;85:258- 66. https://doi.org/10.1097/00006534-199002000-00016
  4. Kawashima T, Harii K, Ono I, et al. Intraoral and oropha- ryngeal reconstruction using a de-epithelialized forearm flap. Head Neck 1989;11:358-63. https://doi.org/10.1002/hed.2880110413
  5. Takato T, Harii K, Ebihara S, et al. Oral and pharyngeal re- construction using the free forearm flap. Arch Otolaryngol Head Neck Surg 1987;113:873-9. https://doi.org/10.1001/archotol.1987.01860080079022
  6. Soutar DS, Tanner NS. The radial forearm flap in the management of soft tissue injuries of the hand. Br J Plast Surg 1984;37:18-26. https://doi.org/10.1016/0007-1226(84)90035-3
  7. Foucher G, van Genechten F, Merle N, et al. A compound radial artery forearm flap in hand surgery: an original modi- fication of the Chinese forearm flap. Br J Plast Surg 1984;37: 139-48. https://doi.org/10.1016/0007-1226(84)90001-8
  8. Soutar DS, Scheker LR, Tanner NS, et al. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983;36:1-8.
  9. Richardson D, Fisher SE, Vaughan ED, et al. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg 1997;99:109-15. https://doi.org/10.1097/00006534-199701000-00017
  10. Toschka H, Feifel H, Erli HJ, et al. Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function. Int J Oral Maxillofac Surg 2001;30: 42-8. https://doi.org/10.1054/ijom.2000.0005
  11. Nehrer-Tairych GV, Millesi W, Schuhfried O, et al. A comparison of the donor-site morbidity after using the prelami- nated fasciomucosal flap and the fasciocutaneous radial forearm flap for intraoral reconstruction. Br J Plast Surg 2002;55:198-202. https://doi.org/10.1054/bjps.2002.3812
  12. Werle AH, Tsue TT, Toby EB, et al. Osteocutaneous radial forearm free flap: its use without significant donor site morbidity. Otolaryngol Head Neck Surg 2000;123:711-7. https://doi.org/10.1067/mhn.2000.110865
  13. Brown MT, Cheney ML, Gliklich RL, et al. Assessment of functional morbidity in the radial forearm free flap donor site. Arch Otolaryngol Head Neck Surg 1996;122:991-4. https://doi.org/10.1001/archotol.1996.01890210063014
  14. Brown MT, Couch ME, Huchton DM. Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest. Arch Otolaryngol Head Neck Surg 1999;125:1371-4. https://doi.org/10.1001/archotol.125.12.1371
  15. Suominen S, Ahovuo J, Asko-Seljavaara S. Donor site morbidity of radial forearm flaps: a clinical and ultrasonographic evaluation. Scand J Plast Reconstr Surg Hand Surg 1996;30: 57-61. https://doi.org/10.3109/02844319609072405
  16. Lutz BS, Wei FC, Chang SC, et al. Donor site morbidity after suprafascial elevation of the radial forearm flap: a prospective study in 95 consecutive cases. Plast Reconstr Surg 1999;103:132-7. https://doi.org/10.1097/00006534-199901000-00021
  17. Bardsley AF, Soutar DS, Elliot D, et al. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg 1990;86:287-92. https://doi.org/10.1097/00006534-199008000-00014
  18. Timmons MJ, Missotten FE, Poole MD, et al. Complications of radial forearm flap donor sites. Br J Plast Surg 1986; 39:176-8. https://doi.org/10.1016/0007-1226(86)90078-0
  19. Sardesai MG, Fung K, Yoo JH, et al. Donor-site morbidity following radial forearm free tissue transfer in head and neck surgery. J Otolaryngol Head Neck Surg 2008;37:411-6.
  20. Singer AJ, Arora B, Dagum A, et al. Development and validation of a novel scar evaluation scale. Plast Reconstr Surg 2007;120:1892-7. https://doi.org/10.1097/01.prs.0000287275.15511.10

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