Oromandibular Reconstruction with the Radial-Forearm Osteocutaneous Flap: Experience with 60 Consecutive Cases

Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: An 8‐year review of complications and flap survival

“…In a study of 60 consecutive osteocutaneous RFFF reconstructions published by Thoma et al, 13 a maximum harvest length of 14 cm was also reported (range 5 5-14 cm) in the case of 40-year-old woman who required reconstruction secondary to resection of sarcoma. A double osteotomy was also necessitated for proper contouring.…”

“…Numerous series have mentioned the number of osteotomies for reconstruction purposes and supported its efficacy in allowing more flexibility in order to achieve a more natural appearing mandible. 7,[10][11][12][13][14] Despite this fact, defects that require larger segments of vascularized bone and the potential for multiple osteotomies is considered a contraindication for use of the osteocutaneous RFFF by many head and neck surgeons. 6,9,15,16 To address this, Thoma et al 10 conducted a review of 42 patients and concluded that performing both single and double osteotomies on the segment of the harvested radius was safe and led to consistent rates of clinical union between the nonosteotomized and osteotomized groups.…”

“…Although complications were noted among both groups of patients, the Thoma et al 10 study did not explicitly demonstrate the sequelae of varying numbers of osteotomies or segment length on recipient-site complications. A second retrospective review was completed by Thoma et al 13 and confirmed that the radial bone graft may be safely osteotomized; however, no mention of the correlation between flap complications and the number of osteotomies was included. Our single-institution review contained a similar breakdown of patients receiving an osteotomized radius.…”

“…Recently, the application of a vacuum-assisted closure system has been used to achieve higher rates of primary skin graft take. 17 Additionally, Thoma et al 13 suggests that suturing of the flexor superficialis muscle and flexor pollicis longus to the edge of the brachioradialis tendon enhances the anchoring of the skin graft and limits exposure of the underlying tendons. This approach is also performed at our institution in order to facilitate successful take of the skin graft and to limit tendon exposure.…”

“…6,9,15,16 In the literature, the incidence of radial fracture has ranged greatly; however, the majority of studies report a rate of less than 30%. 10,13,[18][19][20] Nonetheless, the unacceptable morbidity associated with radial fracture caused the osteocutaneous RFFF to decline in popularity. In order to address the objectionable rate of radial fractures, prophylactic internal fixation after graft harvest of the donor radius was introduced.…”