Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction

Abstract

The osteocutaneous RFFF is a robust flap that can be used to reconstruct composite defects involving bone and soft-tissue beyond the mandible.

Rates of bone reabsorption and union in mandibular reconstruction using the osteocutaneous radial forearm free flap

“…Certain mandibular defects are more amenable to reconstruction with OCRFFF including defects of the ascending ramus, angle, and the nontoothed‐bearing area of the body 31 . All in all, the use of the OCRFFF for head and neck defects including naso‐orbital‐ethmoid, alveolar, and maxillary defects is well documented 2,8–12 . However, there remains hesitation in the head and neck community regarding the use of OCRFFF for osseous reconstruction due to concerns of adequacy and reliability of radial bone stock.…”

“…Currently, the OCRFFF is used for reconstruction of various osseous head and neck defects from mandibular, naso‐orbital‐ethmoid, alveolar, to maxillary defects 2,8–12 . Despite common usage and well‐documented outcomes, there remains concern that the radius bone is of poor quality, providing a short segment of unicortical bone that is easily devascularized or resorbed with only limited indications 2,12,13 …”

Comparaison between Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) Flap in Head and Neck Reconstruction

“…The flap has the advantage of the long pedicle which makes it accessible for insetting in different regions. In addition, the thin flap, and availability to be folded makes it suitable for both coverage and lining to reconstruct both the outer surface and the mucosa of the oral and nasal cavities, in addition, the radial artery is not likely affected by atherosclerosis [5,[10][11][12][13][14]]. Yet, the flap has some disadvantages which include: A relatively small size and bulk, which makes it unsuitable for larger defects or defects requiring bulk, donor site scarring Anterolateral thigh flap (ALT) is a relatively recent workhorse for reconstruction that is used for tissue coverage and replacement in variable body parts.…”

Safety of fibula free flap in patients following total knee replacement

“…Given the prevalence of knee replacement, it is not uncommon for the head and neck surgeon to encounter a patient with prior TKA during preoperative evaluation. In some instances, when a FFF is not possible due to prior trauma or peripheral vascular disease, most surgeons will turn to the osteocutaneous radial forearm (OCRFF) or scapular free flap 1,10 . A few have also harvested the anterolateral thigh osteocutaneous flap (ALTO) 11 .…”

“…In some instances, when a FFF is not possible due to prior trauma or peripheral vascular disease, most surgeons will turn to the osteocutaneous radial forearm (OCRFF) or scapular free flap. 1,10 A few have also harvested the anterolateral thigh osteocutaneous flap (ALTO). 11 Despite these alternative options, for large segment defects, it is difficult to replace the amount of bone afforded by the FFF.…”