An algorithm to improve outcomes of radial forearm flap donor site

D’Arpa, Salvatore; Cillino, Michele; Mazzucco, Walter; Rossi, Matteo; Mazzola, S; Moschella, Francesco; Cordova, Adriana

doi:10.1080/00015458.2017.1411555

Cited by 7 publications

(18 citation statements)

References 32 publications

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“…It is often necessary to cover the donor site with a skin graft, resulting in further morbidity in yet another area of the patient’s body. Although there exist many ways of closing an RFFF donor site, there are, as of yet, no established protocols for the management of a problematic donor site, despite attempts at creating this 12. In the authors’ experience, the donor site outcome is generally better if a suprafascial flap can be raised and the donor site can be closed directly or with a local tissue flap, instead of a skin graft.…”

Section: Discussionmentioning

confidence: 92%

Repair of a postaural fistula with a suprafascial radial forearm free flap

2022

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We describe the case of a patient with the rare complication of a chronic postaural fistula following repeated and extensive surgery and adjuvant radiotherapy to the head and neck for a pleomorphic adenoma of the parotid gland. This case demonstrates the importance and value of thorough preoperative planning for major head and neck reconstruction, particularly if the area for reconstruction has distorted anatomy due to prior treatment or damage. In complex free flap reconstruction, it is important to investigate the recipient site with the help of arteriography and give due consideration to the donor site and its postoperative management. We highlight the importance of multidisciplinary work for the care of these patients not only intraoperatively, but also in the preoperative planning stage, and perhaps most importantly in the postoperative care.

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Section: Discussionmentioning

confidence: 92%

Repair of a postaural fistula with a suprafascial radial forearm free flap

2022

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“…The optimal way of reconstructing the forearm to reduce the RFFF donor morbidity remains controversial, with multiple methods described in the literature (Bonaparte et al, 2013; Chang et al, 2010; D'arpa et al, 2017; Hamahata et al, 2016; Hanna et al, 2014; Ho et al, 2006; Lee et al, 2011; Murray et al, 2011; Shaikh et al, 2018). Direct closure of the forearm is the best choice if possible, but its application is restricted to narrow wounds (Loeffelbein et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…However, recently the RFFF has fallen out of favor due to its unfavorable donor site morbidity with a complication rate in the literature ranging between 6% and 50% (D'arpa et al, 2017; Richardson et al, 1997). Reported donor site complications includes exposure of underlying tendon, delayed wound healing, impaired sensitivity, wrist stiffness, decreased pinch and grip strength, and poor cosmetic scar (Chang et al, 2010; Pabst et al, 2018; Rieger et al, 2016; Zuo et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The arterialised saphenous venous flow‐through flap for managing the radial forearm free flap donor site

et al. 2022

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Background The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. Method A cohort study of six patients (five male, one female; mean age 59 [range 19–90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra‐flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. Results In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6–15 cm (mean 11.5 cm) and widths of 4–6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24–90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow‐up of 6 months (4–24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. Conclusion The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.

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“…The complications of this method are relatively common, and the aesthetic result is sometimes pure. Therefore, a number of alternative methods have been used: full thickness skin graft, local skin flap, tissue expansion, vacuum assisted closure (VAC), cell cultures, synthetic skin substitutes (35)(36)(37)(38)(39)(40)(41)(42)(43)(44). No one of these is ideal and many researches are still focused on the donor site of RFF (32,34).…”

Section: Discussionmentioning

confidence: 99%

Radial Flap in Reconstructions of the Hand - Case Series Study

Vulović

Kozarski

Curcic

et al. 2022

Serbian Journal of Experimental and Clinical Research

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Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2x3.1cm to 9x13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

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An algorithm to improve outcomes of radial forearm flap donor site

Cited by 7 publications

References 32 publications

Repair of a postaural fistula with a suprafascial radial forearm free flap

Repair of a postaural fistula with a suprafascial radial forearm free flap

The arterialised saphenous venous flow‐through flap for managing the radial forearm free flap donor site

Radial Flap in Reconstructions of the Hand - Case Series Study

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