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

Abstract

One of the more difficult problems in reconstructive surgery of the head and neck is replacement of bone and soft tissue lost because of injury, osteomyelitis, or malignancy. The radial-forearm osteocutaneous flap is an accepted choice for oromandibular reconstruction. This study was undertaken to review one center's experience with 60 consecutive cases of oromandibular reconstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, flap failure rate, recipient- and donor-site complications, length of surgery, and hospital stay. Cancer resection was the reason for 97 percent of reconstructions; 33 percent of flaps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Mean skin flap size was 55 cm2 (range, 15 to 117 cm2) and mean bone length, 9.4 cm (range, 5 to 14 cm). The microvascular success rate was 98.3 percent. Complications included fracture of the donor radius (15 percent), nonunion of the mandible (5 percent), and hematoma (8.3 percent). These results are comparable to results reported in the literature with other radial forearm flaps. The free radial osteocutaneous flap is a safe and reliable choice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomosis to the contralateral side of the neck. The above attributes make the radial forearm osteocutaneous flap one of the "first line" flap choices for oromandibular reconstruction.

The use of the Radial Styloid in the Extended Osteocutaneous Radial Forearm Free Flap

“…A fracture can be a significant setback for patients because it may delay recovery and rehabilitation. Operative repair is often not straightforward given the presence of skin grafts, scar and a bony defect requiring bone graft (19,20).…”

“…Early reports have a 15% to 30% incidence of radius fractures (19,21,22). Subsequently, biomechanical studies demonstrated the benefit of PIF (6), limiting the osteotomy to 30% of the circumference (23), and bevelling at the proximal and distal ends (13,23,24).…”

“…The fracture risk without PIF is not 100% (19,21,22) and prophylactic plating has not eliminated fractures (3,10). Studies have indicated that harvesting bone from the radius significantly impacts the strength of the bone (23,24).…”

Colgajo radial: experiencia del equipo de Cirugía Plástica de la Universidad de Chile

“…Hemos podido aprender de sus fortalezas y mejorar sus debilidades; destacando entre las ventajas más importantes el hecho de que nos permite utilizar piel, músculos, tendones, tejido adiposo, hueso y nervio según necesidad 8 , aportando piel fi na, sin pelo, de color y textura similares a la piel de la cara y el cuello 9 . El componente cutáneo del colgajo es ideal para la cobertura de mucosas, ya que con el tiempo termina modifi cando su epitelio hasta convertirse en mucosa oral y/o nasal [10][11][12][13] , se caracteriza también por ser maleable, fl exible y resistente en el tiempo 14 , no tiene contraindicaciones de edad o patologías asociadas 15 y la zona dadora mantiene su funcionalidad con un acotado compromiso estético y de baja morbilidad. La toma del colgajo es una técnica relativamente simple, se obtiene un "largo" pedículo vascular, de buen diámetro, que permite transferir tejidos a mayor distancia de la zona dadora, sin necesidad de microcirugía 2 .…”

18 Reconstruction of the Mandible

“…[19][20][21] Composite RAFF which had been proposed in the earlier years has become very much less used now due to the inadequate quality and quantity of the bone available as well as the need for prolonged protection of the forearm to prevent fracture of the residual radial bone. [22][23][24] …”