The Forearm Flap

Song, Ruyao; Cao, Yuzhi; Song, Yeguang; Yu, Yuseng; Song, Yeliang

doi:10.1016/s0094-1298(20)30369-2

Cited by 518 publications

(119 citation statements)

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“…Radial forearm free flap (RFFF) has become the favored option for correcting defects after ablative tumor surgery of the oral cavity. Introduced as the "Chinese flap" by Yang et al (3) in 1981 and Song et al (4) in 1982, it has multiple advantages (3,4). Based on its long high-caliber pedicle, reliability of anatomical structures, and overall the ease of grafting qualifies it as an ideal flap for microsurgical reconstructions.…”

Section: Introductionmentioning

confidence: 99%

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

et al. 2019

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Introduction: Surgery to resect intra-oral malignancy is a well-established mode of primary treatment. The tissue requirement in this area is for a thin, pliable flap with minimal bulk and this has historically been provided by free tissue transfer with a radial forearm free flap (RFFF). More recently, a role for the anterolateral thigh free flap (ALTFF) has been described, although in populations with a westernized diet, body habitus may preclude use of an ALTFF due to flap thickness, relative to a radial forearm free flap. Methods: An analysis of data was performed retrospectively for 90 consecutive patients with intra-oral malignancy, requiring immediate soft tissue reconstruction by the senior author, at Addenbrooke's Hospital between July 2008 and April 2016. Cases requiring bony reconstruction were excluded. Data on patient age, sex, indication for surgery, tumor location and defect type, complications, success rates, and length of stay were recorded. Results: The majority of patients received an ALTFF (n = 56) with 38% receiving a RFFF (n = 34). Surgical resection took place in the floor of the mouth most frequently. These were closed with ALTFF and RFFF in 41 and 28 occasions, respectively. A success rate of 97% was observed in the RFFF group; 1 flap developed partial necrosis and required complete revision. In the ALTFF group, there was a 100% flap success rate. ALTFF usage resulted in a reduction in the number of intraoperative (p = 0.021) in addition a reduction in the number of days in ITU (p = 0.01) and post-operative clinic visits (p = 0.025). Conclusion: We present a series that used predominately the ALTFF to reconstruct intra-oral defects following resection of squamous cell carcinoma in a Western population. The results demonstrate that this treatment can produce at least as comparable results as to the use of a RFFF repair in this population, whilst avoiding the donor site morbidity and aesthetic compromise of a RFFF.

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Section: Introductionmentioning

confidence: 99%

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

et al. 2019

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“…In comparison with traditional methods such as split thickness skin grafting, the overall complication rate is minimized because hand motion can be allowed earlier, with the flexor tendons sliding beneath the flap. Soutar et al reported 28% of problems in extension of wrist with traditional method [5]; we have no such reports in modified groups because of primary closure in the later group. Studies by Fenton et al reports specifically the aesthetic problems in traditional method of radial forearm flap [24].…”

Section: Discussionmentioning

confidence: 60%

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators & Its Clinical Applications in Head & Neck Reconstruction

Sham¹,

Masia²,

Reddy³

2018

IJOHNS

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Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.

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“…Since its original description by Song et al. [17] and Chang and Hwang [16] penile reconstruction using the RAFF has proven to be superior to all other techniques, as it: (i) guarantees a superior cosmetic result by forming a cylindrical phallus rather than the wedge‐shaped infra‐umbilical and groin flap phalloplasty [5–10], and is less prone to postoperative contracture than musculocutaneous flaps [11–16]. (ii) Allows the creation of a neourethra that reaches the tip of the phallus, which is less prone to complications.…”

Section: Discussionmentioning

confidence: 99%

“…Originally described in 1982 by Song et al. [17], the use of the radial‐artery free flap (RAFF) phalloplasty was first published in 1984 by Chang and Hwang [16], who used this technique successfully for TPR in seven patients that had previously had a penile amputation. The reconstructive procedure involved the creation of ‘a tube within a tube’ using forearm skin with the urethra fashioned from the non‐hair‐bearing area and the whole flap base on the radial artery.…”

Section: Introductionmentioning

confidence: 99%

Total phallic reconstruction after penile amputation for carcinoma

et al. 2009

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OBJECTIVE To report our experience of total phallic reconstruction (TPR) with the use of the radial‐artery free flap (RAFF) in patients who have had a subtotal penectomy for penile or urethral cancer, as the goal of TPR is the creation of a sensate and cosmetically acceptable phallus with an incorporated neourethra that allows the patient to void while standing, and with the insertion of a penile implant to resume sexual activities, improving quality of life. PATIENTS AND METHODS The notes of the 15 patients who had undergone RAFF TPR between January 1998 and May 2008 were reviewed retrospectively. The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery and patient satisfaction were recorded during the follow‐up. RESULTS This technique allowed the reconstruction of a cosmetically acceptable phallus in all patients. After a median (range) follow‐up of 20 (1–68) months all patients were satisfied with the cosmesis and size of the phallus, and 14 were able to void while standing. Among the seven patients who have subsequently had insertion of a penile prosthesis, five can now engage in sexual intercourse. Urethral strictures and fistulae were the commonest complications in, respectively, three and four cases, and one patient had his penile prosthesis explanted because of infection. CONCLUSIONS RAFF phalloplasty is an excellent technique for TPR, giving excellent cosmetic and functional results.

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The Forearm Flap

Cited by 518 publications

References 0 publications

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators & Its Clinical Applications in Head & Neck Reconstruction

Total phallic reconstruction after penile amputation for carcinoma

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The Forearm Flap

Cited by 518 publications

References 0 publications

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators &amp; Its Clinical Applications in Head &amp; Neck Reconstruction

Total phallic reconstruction after penile amputation for carcinoma

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Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators & Its Clinical Applications in Head & Neck Reconstruction