Novel technique for the direct closure of the radial forearm flap donor site defect with a local bilobed flap

Mashrah, Mubarak Ahmed; Yan, Liang; Handley, T. P. B.; Pan, Chaobin; Chen, Wei‐Liang

doi:10.1002/hed.25839

Cited by 21 publications

(18 citation statements)

References 27 publications

(61 reference statements)

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“…A study by Pirlich et al compared functional outcomes between donor-site closure with an FTG or direct closure; however, no substantial difference in pain incidences was found between the two techniques. 28 Four studies used flaps for donor-site closure, including an anterolateral thigh flap 29 , an ulnar-based transposition flap 13 , a bilobed flap 30 , and a keystone flap 19 , however no considerable differences compared to skin graft closure were found. The difficulty in distinguishing the origin of donor-site pain between the different nerves or skin grafts emphasizes how little is known regarding this problem so far, and highlights the importance of investigating this in future studies.…”

Section: Discussionmentioning

confidence: 99%

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Bruin

Hundepool

Duraku

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Background: The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. Methods: A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. Results: Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. Conclusion:The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should

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Section: Discussionmentioning

confidence: 99%

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Bruin

Hundepool

Duraku

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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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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“…They are thin, easily harvested, extremely reliable, can be moldable in three dimensions, and offer large‐caliber vessels. On the other hand, donor site morbidity continues to be a major disadvantage of both RFF and UFF 13 . Some inherent disadvantages of RFF can be avoided by using UFF, such as donor site being easier to conceal, relatively hairless skin, altered sensation, and fewer wound healing complications 10,14 …”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, donor site morbidity continues to be a major disadvantage of both RFF and UFF. 13 Some inherent disadvantages of RFF can be avoided by using UFF, such as donor site being easier to conceal, relatively hairless skin, altered sensation, and fewer wound healing complications. 10,14 Donor site morbidity is crucial in deciding which free flap to use to reconstruct soft tissue defects.…”

Section: Discussionmentioning

confidence: 99%

Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self‐controlled study

Al-Aroomi

Mashrah

et al. 2022

Head & Neck

Self Cite

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Background: There is a shortage of well-designed self-controlled studies evaluating hand biomechanics following ulnar forearm flap (UFF) harvest. This study was conducted to evaluate objective and subjective functional outcomes of the donor's hand following UFF harvest. Methods: All patients undergoing UFF were included for analysis. Grip strength, wrist movement, forearm supination and pronation, pinch strengths, sensation to light touch and temperature, and hand dexterity were assessed preoperatively and at 1, 3, and 6 months postoperatively.In addition, DASH score (disabilities of the arm, shoulder, and hand score) and Patient and Observer Scar Assessment Scale (POSAS) were analyzed.Results: A total of 18 patients were enrolled. A significant reduction in grip strength for donor's hand was observed between preoperative and postoperative 1 and 3 months (mean difference = 14 kg, 7.38 kg, respectively, p = 0.000 for all). A similar trend was observed for pinch strength and range of motion (p < 0.05). Three months after surgery, there is still a significant reduction in tip pinch, tripod pinch, wrist extension, and supination. All biomechanics outcomes returned to preoperative baseline at 6 months after surgery. No patients suffered significant changes in sensation to light touch, temperature, and numbness by 6 months. There was a significant increase in DASH score by 3.37 points 6 months after operation (p = 0.000). The POSAS score indicates satisfaction with the appearance of the donor site. Conclusions: UFF is a safe and reliable option for oral cavity reconstruction with minimum donor site morbidities, mainly when cosmesis is paramount. Furthermore, objective hand biomechanics ultimately returns to its preoperative state within 6 months after surgery.

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Novel technique for the direct closure of the radial forearm flap donor site defect with a local bilobed flap

Cited by 21 publications

References 27 publications

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Radial Flap in Reconstructions of the Hand - Case Series Study

Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self‐controlled study

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