Radial vs ulnar forearm flap: a preliminary study of donor site morbidity

Abstract

SUMMARYThe objective of this study was to compare donor site morbidity after reconstructive surgery with Ulnar Forearm Free Flap (UFFF) and Radial Forearm Free Flap (RFFF) with subjective methods. The UFFF and the RFFF were applied for reconstruction of soft tissue defects of the head and neck region in 30 patients (20 M and 10 F; age range 28-75 years) affected by head and neck squamous cell carcinoma. The Disability of Arm, Shoulder and Hand (DASH) questionnaire was used to assess morbidity of the donor site. Analysis of the patients’ DASH scores showed an overall median DASH total score of 9.17. No significant differences were observed for median values of the RFFF and UFFF groups (7.14 vs 10 respectively) or for the values in males and females (5 vs 13.3 respectively). The UFFF can be considered a valid alternative to the RFFF for reconstruction of soft tissue defects of the head and neck area; it is safe, easy to harvest and is not associated with major morbidities of the donor site as demonstrated by the DASH questionnaire.

Evaluation of hyperspectral imaging to quantify perfusion changes during the modified Allen test

“…By giving profound information on tissue perfusion, HSI holds great potential in the postoperative surveillance of flaps and the early detection of the most common reasons for flap failure, thus arterial insufficiency or venous congestion 59 . The radial forearm free flap is widely used for head and neck reconstructive surgery, 60–62 while the use of an ulnar forearm free flap has only occasionally been reported 41,42 . The proper function of the arterial and venous anastomosis after reconstruction is essential for the survival of free flaps.…”

“…59 The radial forearm free flap is widely used for head and neck reconstructive surgery, [60][61][62] while the use of an ulnar forearm free flap has only occasionally been reported. 41,42 The proper function of the arterial and venous anastomosis after reconstruction is essential for the survival of free flaps. Although success rates are usually cited at 95% or higher, there is still a relevant number of flap failures.…”

“…[36][37][38] Yet, an intact superficial palmary arch is also crucial before the less commonly performed ulnar forearm free flap is harvested. 41,42 Another established approach to assess the microcirculation of the hand is to use a cuff occlusion test (COT) at the upper arm, which has been widely used as a comparative test for microcirculation monitoring before [43][44][45] and has already been reported in combination with HSI on a few patients. 16,24,[46][47][48] The purpose of this study was to both, qualitatively and quantitatively assess microcirculation of the hand in healthy volunteers during both a MAT and a COT at the upper arm using HSI.…”

“…For this application, it is considered a fast, easy, and valid clinical tool, 33,40 even though some authors criticize its sole use and claim the application of an additional objective test 36–38 . Yet, an intact superficial palmary arch is also crucial before the less commonly performed ulnar forearm free flap is harvested 41,42 . Another established approach to assess the microcirculation of the hand is to use a cuff occlusion test (COT) at the upper arm, which has been widely used as a comparative test for microcirculation monitoring before 43–45 and has already been reported in combination with HSI on a few patients 16,24,46–48 …”

Long-Term Donor Site Morbidity and Flap Perfusion Following Radial versus Ulnar Forearm Free Flap—A Randomized Controlled Prospective Clinical Trial

“…This was due to the incorrect assumption that the UFFF artery is the dominant vascular supply to the palm [3,4]. The elastic and soft nature of the skin is particularly suitable for reconstructions of the head and neck region and frequently provides good functionality and aesthetics [5,6]. The above-mentioned criteria lead to different indications with regard to the choice between UFFF and RFFF.…”