The beavertail modified radial forearm free flap: Retrospective review of a versatile technique to increase flap bulk in the head and neck

Abstract

ObjectiveUtilization of free tissue transfers in head and neck reconstruction has greatly increased due to their dependability and reliability. Anterolateral thigh (ALT) and rectus abdominus (RA) free flaps may provide too much soft tissue bulk, especially in patients with a large body habitus. A radial forearm free flap (RFFF) may be modified with a “beaver tail” (BT), which provides a flap whose bulk may be tailored to a defect. The purpose of this paper is to describe the technique, how it can be used for a variety of defects and the outcomes of these reconstructions.MethodsA retrospective review of prospectively collected data was performed at single tertiary care center between 2012 and 2022. BT‐RFFF was designed by leaving a fibroadipose tail vascularized to branches of the radial artery or separated from the vascular pedicle and left attached to the proximal portion of the skin paddle. Functional outcomes, tracheostomy dependence, and gastrostomy tube (G‐tube) dependence as well as complications were determined.ResultsFifty‐eight consecutive patients undergoing BTRFFF were included. Defects reconstructed included: oral tongue and/or floor of mouth 32 (55%), oropharynx 10 (17%), parotid 6 (10%), orbit 6 (10%), lateral temporal bone 3 (5%), and mentum 1 (2%). Indications for BTRFF were: need for bulk when the ALT and RA were too thick (53%) and need for a separate subcutaneous flap for contouring or deep defect lining (47%). Complications directly related to beavertail included a widened forearm scar (100%), wrist contracture (2%) partial flap loss (2%), and flap loss requiring a revision flap (3%). Ninety‐three percent of patients with oral/oropharyngeal defects and 12‐month follow‐up tolerated oral intake without aspiration and 76% were tube‐independent. Ninety‐three percent were tracheostomy‐free at last follow‐up.ConclusionThe BTRFF is a useful tool for reconstructing complex 3D defects requiring bulk where an ALT or rectus would otherwise provide too much bulk.

Tongue Reconstruction with Buccinator Myomucosal Island Flaps: Technical Considerations, Oncologic Safety, Functional Outcomes and QoL Assessment—A Retrospective Observational Study

“…These methods range from direct closure [ 6 , 7 ], local flaps [ 8 , 9 , 10 ], regional flaps [ 11 , 12 ] to free flaps [ 13 , 14 ], each offering different benefits and challenges. While radial forearm (RF) and anterolateral thigh free flaps (ALT) are currently the gold standard for tongue reconstruction, providing satisfactory functional rehabilitation [ 15 , 16 ], buccinator myomucosal island flaps offer a promising alternative. Buccinator myomucosal island flaps are advantageous due to their minimization of donor-site morbidity and reduced surgery and hospitalization time.…”

Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head and Neck Reconstruction

“…1,2 Since then, derivations of the lateral arm flap, including the extended lateral arm and lateral forearm flaps, have been described, allowing for thinner fasciocutaneous options. [3][4][5][6][7] Unlike radial and ulnar forearm flaps, the lateral arm is almost always closed primarily without the need for skin grafts or exposure of nerves and tendons. [8][9][10][11] Also, a major artery to the hand is not sacrificed, and the color match is often better for external defects.…”

“…The lateral arm free flap, based on the posterior radial collateral artery and its venae comitantes, was first introduced in the 1980s 1,2 . Since then, derivations of the lateral arm flap, including the extended lateral arm and lateral forearm flaps, have been described, allowing for thinner fasciocutaneous options 3‐7 . Unlike radial and ulnar forearm flaps, the lateral arm is almost always closed primarily without the need for skin grafts or exposure of nerves and tendons 8‐11 .…”