• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.122-128
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• 1998

Radial forearm flap is one of the most useful skin flap in hand reconstructuion with distally based reverse pedicled or free vascularized fashion. Athors modified that flap into reverse pedicled and free vascularized flap which has advantages of both methods. The modification composed with harvesting flap on recipient side distal forearm just as free flap, than apply it as reverse distal pedicled flap fashion with microvascular anastomosis with distal vascular stump of donor radial vessels. We underwent this method in 5 cases in finger reconstruction from 1996, all of the cases had sucessful results. The advantages of this method are: 1. Thin flap which is compatible to finger skin can harvest from distal forearm with very long vascular pedicle that can be passed under the subcutaneous tunnel which avoid additional skin incisions on the hand. 2. The vessels of donor site and recipient site are same vessel in effected side of forearm, which can preserve contralateral side forearm and hand keep intact. 3. The flap can cover the defects on distal portion of the fingers which is difficult in conventional reversed radial forearm pedicled flap because of limited mobilization of flap due to limitation of pedicle length reach to tip of the fingers.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.305-318
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• 1991

Reconstructive techniques of orofacial defects are very varied. In recent years, myocutaneous flaps, in particular the pectoralis major or latissimus doris myocutaneous flap have achieved popularity. In 1983, Soutar et. al. used the forearm free flap that had been developed in in China and popularised the radial forearm fasciocutaneous flap to reconstruct defects in the orofacial region. This paper presents the authors experience with 10 consecutive patients in which 12 flaps were used either as a fascioncutaneous flap or as a composite flap incorporating part of the radius. Some literatures were reviewed and the clinical results were discussed.

• Korean Journal of Bronchoesophagology
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• v.3 no.2
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• pp.307-312
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• 1997

Reconstruction of the pharyngoesophagus is one of the most difficult challenges in head and neck surgery. The goals of pharyngoesophageal reconstruction include restoration of a person's ability to swallow and to speak with minimal morbidity, but no current reconstruction modality is clearly best. Following its first introduction as fasciocutaneous flap by Yang in 1981, the forearm flap based on radial artery has become recognized as a very reliable and relatively easy one to use. The forearm flap has thin, pliable and predominantly hairless skin and scant subcutaneous layer In addition, its vascular pedicle is long and of large caliber, which greatly increases the chance of successful revascularization. The forearm flap shows the potentiality for better functional rehabilitation in swallowing and speech as well as the possibility of three dimensional reconstruction. We experienced a case of radial forearm free flap for the reconstruction in a patient with the hypopharyngeal stricture. The early return of oral feeding was possible and successfully enough to return to the normal daily activity.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.365-371
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• 2009

Purpose: Good color match holds a key position in facial reconstruction for good aesthetic result. To correct the wide facial soft tissue defect were usually used the tissue expanded cheek flap, deltopectoral flap or radial forearm free flap. This study is aimed to analyse the color difference after flap surgery by using chromameter. Method: From August 1995 to December 2006, 30 patients underwent flap operations were chosen randomly and evaluated color differences between flap site and adjacent skin. Reconstructive procedures included tissue expanded cheek flap(n = 10), deltopectoral flap(n = 10), and radial forearm free flap(n = 10). The measured sites were flap center within a radius of 1 ㎝ and four points of adjacent skin along the flap margin. The color was quantified in a three dimensional coordinate system $L^*$ (brightness), $a^*$ (redness), $b^*$ (yellowness). Results: There was no significant color difference between the pedicled flaps(tissue expanded cheek flap and deltopectoral flap) and adjacent skin area. On the other hand, color values of the radial forearm free flap were statistically different from those of adjacent skin area. Total color difference(${\Delta}E$) of tissue expanded cheek flap and deltopectoral flap were $7.45{\pm}5.78$ versus $9.41{\pm}7.09$, and that of radial forearm free flap was $11.74{\pm}3.85$. They suggest that pedicled flaps have a potential of better color match than radial forearm free flap. Conclusion: Thus, better esthetic result and satisfaction is more likely to be expected in pedicled flaps as long as it could be applied comparing radial forearm free flap.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.60-63
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• 2001

The reconstruction of the suborbital area followed by resection of skin cancer has been used many methods including skin graft, local flaps, free flaps, and skin expansion. The radial forearm free flap has become a workhorse flap in this area because of its lack of bulk, ease of dissection, malleability, and hairlessness. When the suborbital defect especially including full-thickness defect of lower lid was reconstructed with many free flaps, the ectropion and the deformity of medial and lateral canthal area were common problems encountered as late complication due to gravitational descent. To improve the final aesthetic result in patients with suborbital defect, the radial forearm free flap was elevated as a composite radial forearm - palmaris longus free flap, in which the vascularized palmaris longus london was included and anchored to the periorbital bone with $mitek^{(R)}$ as sling, to suspend the flap against gravity and inferior descent, and thereby creating a more natural cheek contour. Two clinical cases were presented as an example of this procedure. Postoperative results emphasize the importance of suspension sling with palmaris longus tendon using $mitek^{(R)}$ in reconstruction of the suborbital defect with radial forearm free flap.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.769-775
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• 2015

Background The radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap. Methods In this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance. Results Only one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars. Conclusions Performing the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.80-86
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• 1997

The lateral arm flap was reported first by Song et al. in 1982, and Katsaros and colleagues described an anatomic study and clinical cases in 1984. This flap is thin, has relatively constant vascular anatomy, and provides relatively acceptable scar at the donor site. Despite its many advantages its wide application has been limited by its short vascular pedicle with small diameter of lumen, and its small skin paddle. We studied its anatomical structure to get longer length of vascular pedicle, wide diameter and thinner part of flap beyond the lateral condyle through 6 fresh cadaver dissection and dye injection study. We experienced 21 cases of lateral arm free flaps and 26 cases of forearm free flaps from May, 1992 to January, 1996. We compared its usefulness with forearm free flaps in the aspects of donor morbidity, operative factors, quality of flap, and versatility. In conclusion, lateral arm flap can replace the role of forearm flap in most cases so that patient's donor morbidity can be reduced especially in the women.

• 대한두경부종양학회:학술대회논문집
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• 2007.05a
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• pp.80-84
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• 2007

Background and Objectives : The radial forearm free flap is a useful reconstructive method of surgical defects after oral and oropharyngeal tumor resection. We evaluated the swallowing and speech outcomes of radial forearm free flap reconstruction for oral and oropharyngeal cancers. Materials and Methods : We retrospectively reviewed clinical data of 84 patients who underwent reconstructive surgery for oral or oropharyngeal cancer using radial forearm free flap from August 1994 to January 2007. Modified barium swallowing (MBS) was done in 100 patients and speech-language assessment was done in 23 patients by a speech-language pathologist. Results were analyzed according to the swallowing functions and the speech-language assessments. Results : According to the results of MBS which was done postoperatively, aspiration occurred in three patients and velopharyngeal insufficiency occurred in four patients who had been reconstructed with multilobed free flap due to large mucosal defects. There was one patient who exhibited severe articulation impairment out of 23 patients. However, 19 patients out of 23 patients showed excellent intelligibility in speech. Conclusion : We concluded that the radial forearm free flap technique is an excellent reconstructive method for the restoration of palatal and pharyngeal function in oral and oropharyngeal cancer patients.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.646-650
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• 2021

Head and neck reconstruction poses unique challenges in rehabilitating surgical defects in terms of integrity, function, and form. The radial forearm free flap (RFFF) has been widely used for defect coverage, especially in the head and neck area, but its versatility allows it to be used for soft-tissue reconstruction in various parts of the body. The vascular features of the flap are quite constant and reliable. Nevertheless, abnormalities of the forearm vascular tree have been described over the decades. We report a case of intraoral reconstruction after verrucous carcinoma recurrence in a 74-year-old woman with an unusual forearm flap, which we called the median forearm free flap, based on a median branch of the radial artery that was preoperatively detected using handheld Doppler ultrasonography. The distally located skin paddle was predominantly supplied by the aberrant median vessel with its perforators. The flap was thus safely harvested with this atypical pedicle. Successful reconstruction of the intraoral defect was achieved, with an uneventful postoperative course.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.55-59
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• 2001

The hand is a frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, early debridement and synchronous flap coverage are generally accepted as a primary treatment of several electrical burns complicated by exposure of tendons, neurovascular structures, and bones. So, in order to establish convenient, promising methods for the reconstruction of hand defects in electrical burn patients, we performed various reverse forearm flaps. From March 1997 to February 2000, we reconstructed 12 cases of hand defects in high voltage electrical burn wounds with reverse forearm flaps. Reverse radial fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap and STSG were 4 cases, reverse ulnar fascial flap and STSG were 2 cases. We successfully reconstructed hand defects in all 12 cases, and obtained following conclusions. 1 Various reverse forearm flaps provide well vascularized, profitable tissues and they require short operative time with relatively easy procedures. 2. Reverse fascial flap and STSG, reverse fasciocutaneous flap and STSG provide thin flaps with good aesthetics and minor donor site morbidity.