The radial forearm free flap should not be used for every head and neck defect. However, despite excellent results with respect to the site of reconstruction, donor site morbidity cannot be neglected. Urological complications, however, can arise quite frequently and can prevent the patient from urinating in the standing position, an important postsurgical goal for many. Outcomes of the osteocutaneous radial forearm free flap for. Understand the relevant anatomy associated with this procedure.
Radial forearm free flap musculoskeletal system medicine. Radial forearm free flap for partial laryngopharyngectomy radial forearm free flap for partial laryngopharyngectomy paniello, randal c. Clinical reliability of radial forearm free flap in repair. Fiftyseven pedicled 43 reverse and 14 antegrade flow and 10 free radial forearm flaps were performed in 66 patients, including seven fascial flaps and one osteocutaneous flap. Doublelayered collagen graft to the radial forearm free flap. Reconstruction of scalp defects with the radial forearm.
Micro vascular free flaps used in head and neck reconstruction. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. What is the abbreviation for radial forearm free flap. Radial forearm flap 1981 china, 1985 pharyngeal recon oral cavity, base of tongue, pharynx, soft palate, cutaneous defects, base of skull, small volume bone and. Micro vascular free flaps used in head and neck reconstruction certified fixed orthodontic courses by indian dental academy 11,798 views. Free radial forearm flap after partial glossectomy for squamous cell carcinoma of the tongue chuah uc,kamarul t,sara t department of orthopaedic surgery,university of malaya medical centre,50603 kuala lumpur,malaysia abstract. Radial forearm free flap postoperative instructions. Flap choice should be dictated by the needs of the patient and those of the site to be reconstructed. The radial forearm free flap rfff as a fasciocutaneous flap was developed in 1978 in the peoples republic of china but it was soutar and colleagues in 1983 from scotland who popularized the. Radial forearm flap an overview sciencedirect topics. The reverse radial forearm flap potentially offers thin, mobile skin with similar characteristics to the skin.
The radial forearmlateral arm mega free flap sciencedirect. Splinting the radial forearm free flap donor site request pdf. This piece of writing comprised all the detail about harvesting radial forearm free flap, advantages, disadvantages. Doublelayered collagen graft to the radial forearm free. Donor site morbidity following radial forearm free flap.
Radial forearm free flap atlas of operative oral and. Pronation at the wrist, manual dexterity and sensation were found to. The ulnar forearm flap has the advantages of thin and pliable skin, constant and large pedicle, and the teclinical possibility of combination with the muscles, sensory or motor nerve, and ulna. Surgical technique ottie van zyl the radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Article information, pdf download for reverse radial forearm flap to. This study involved nine longterm survivors 2 year postoperative who had forearm free flaps to reconstruct head and neck defects. Radial forearm flap british association of oral and. Harii described the use of a tubed fasciocutaneous free flap for pharyngoesophageal reconstruction in 1985. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal competence during speech and swallowing. Free flaps did not, however, become widely used for hypopharyngeal reconstruction until after the refinement of microvascular techniques during the 1970s. Radial vs ulnar forearm flap acta otorhinolaryngologica italica. Second free radial forearm flap for urethral reconstruction after partial flap necrosis of tube. Because the radial aspect of the arm is hair bearing, the amount and quality of the hair is a consideration in using this flap for resurfacing. It has since become a workhorse for soft tissue replacement in head.
Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Rafff radial artery forearm free flap acronymfinder. Radial forearm free flap for soft palate reconstruction. The list of acronyms and abbreviations related to rfff radial forearm free flap. When this socalled chinese flap was originally described by yang et al. Radial free forearm flap rfff surgical technique vula. Only one patient was reconstructed with a scapular free flap.
When your condition is stable and there is a room available, you will move to. Reduction of donor site morbidity of free radial forearm. Free radial artery forearm flap in reconstruction of oral cavity cancers our experience 88 int j res med. Several types of free flaps can be used to restore defects within the oral cavity and orohypopharynx anterolateral thigh flap, rectus abdominis musculocutaneous flap, free deltoid flap, etc. Submental island flap versus radial forearm free flap for. A total of 58 microvascular free flap reconstructions were performed radial forearm free flap. Learn about the free radial forearm flap, an online 3dvideobased course, accredited by the royal college of surgeons of england.
The use of a prefabricated radial forearm free flap for. Revisiting radial forearm free flap for successful venous drainage. Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Download as an information leaflet pdf radial forearm flap. Jan, 2014 to assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre. Radial forearm free flap phalloplasty is the most commonly performed flap for neophallus construction in the femaletomale ftm transgender patient. Radial forearm free flap iowa head and neck protocols. The purpose of this study was to report the clinical results of doublelayered collagen graft to the donor site of the forearm free. The ulnar artery version of the forearm flap has not been. Large studies have demonstrated their safety and efficacy, with 93% 1 and more recently 96. Using mucosa to construct the fixed urethra and to prelaminate the penile.
It is one of the most common ways of replacing tissue in the head and neck, particularly after mouth cancers have been removed. Nov 22, 2011 radial forearm free flap rfff is a versatile reconstructive method, first described by yang et al. The radial forearm flap is usually used in reconstruction of the mutilated hand as a reverse pedicled flap, but occasionally, a free radial forearm flap can be harvested from the contralateral forearm. A fullthickness paramedian forehead flap supplied external coverage. Harvesting of free radial artery forearm flap fraff. Although forearm free flaps are frequently performed, there is insufficient prospective data looking at the morbidity of the radial compared to ulnar forearm free flaps. Radial forearm free flap postoperative instructions 3 the hospital staff will be doing doppler checks checking for a pulse in the forearm every hour for the first 24 hours, then every 2 hours for the next 24 hours and then every 4 hours while hospitalized. The radial forearm free flap and the ulnar forearm free flap are both welldescribed procedures used for free tissue transfer in reconstructive surgery. Jun 12, 2017 overall procedure of harvesting of free radial artery forearm flap for the closure of defect of wide local excision of carcinoma cheek with marginal mandibulectomy. Double bilobed radial forearm free flap for anterior tongue and floorofmouth reconstruction.
Liu y, jiang x, huang j, wu y, wang g, jiang l, li w, zhao y. Free radial artery forearm flap in reconstruction of oral. Arganbright et al examine and report longterm outcomes and complications at the donor and recipient sites for patients undergoing the osteocutaneous radial forearm free flap for mandibular reconstruction. Osteocutaneous radial forearm free flap in subtotal nasal. Radial forearm flap for tongue reconstruction philippine. We report the use of a free radial forearm flap with multiple perforatorbased skin islands for the reconstruction of complex softtissue defects involving multiple fingers. Radial forearm free flap is regularly used in reconstruction of oral and maxillofacial region after ablative cancer surgeries. Described in 1981 by the chinese authors yang kuofan et al. Use of radial forearm free flaps in oncologic surgery of the head and neck use of radial forearm free flaps in oncologic surgery of the head and neck gapany, markus 20000901 00. Figure 2 omitted in 1981, yang et al in china became the first to describe the radial artery forearm free flap, which is also known as the chinese flap. Comparing it with the radial forearm flap, there is no possibility of exposure of flexor tendons, which usually results in the good take of skin grafts. Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery.
Your hospital stay after radial forearm free flap surgery. The flap was transferred, like bunting, to the injured hand with an exteriorized pedicle. Radial forearm free flap donor site outcomes comparison by. Radial forearm versus the ulnar forearm free flap full text. Radial free forearm flap versus pectoralis major pedicled. Speech intelligibility, swallowing capacity and quality of. Donor site complications secondary to radial forearm free flap rfff reconstruction can limit recovery. Article information, pdf download for coverage of tendon exposure after. A 52year old female with a t3n2cm0 stage iva right tongue carcinoma underwent tracheotomy, right hemiglossectomy with modified radical neck dissection type iii and extended supraomohyoid neck dissection on the left with.
The radial forearm flap has been widely used in reconstructive surgery of head and neck regions. Functional reconstruction of subtotal glossectomy defects with radial forearm free flap. Clinical reliability of radial forearm free flap in repair of. To present a case of tongue reconstruction using radial forearm free flap.
Rfff abbreviation stands for radial forearm free flap. The list of acronyms and abbreviations related to rfff radial forearm free flaps. Indications the forearm flap has been used for just about everything imaginable in the area of head and neck reconstruction. The objective of this study is to test the hypothesis that using a simple and inexpensive preoperative tissue expansion device for radial forearm free flap donor sites will result in a significant. This is surgery that removes a piece of skin from your inner forearm and uses it to replace tissue that was removed due to cancer. Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. This stage involved transferring the radial forearm free flap rfff with cartilage and mucosal graft for closure of the tcf and augmentation of the associated tracheal stenosis fig. Toetothumb transfer has become the gold standard for thumb. Following reconstruction with a radial forearm free flap, duration of hospitalization was shorter. The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in maxillofacial reconstruction. Reverse radial artery forearm flap in a case of giant hairy nevus of.
Tissue defect reconstruction using radial forearm free flap rfff is a common. Overview of a very useful and commonly used procedure. Ab the unique attributes of the radial forearm flap for head and neck reconstruction make it a primary choice from the reconstructive ladder. Fraff or free radial forearm flap involves transfer of tissue from one place of the body the donor site, here the forearm to another site where there is a defect in skin or muscle, for example the cheek, tongue or the pharynx a piece of skin and its underlying soft tissue along with a segment of the artery and vein of the forearm is cut out. The pectoralis major myocutaneous flap pmmf, based on the thoracoacromial artery, was described in. Negative pressure wound dressings npd may increase blood flow and perfusion as compared to static pressure dressings spd designed to minimize. The flap is based on the axis of the radial artery. Haemodynamic changes in the fingers after free radial. Radial forearm free flap fasciocutaneous hns preferences. Pdf free radial forearm flap and anterolateral thigh. We analyzed the superiority and reliability of the flap. Original source unknown fair use notice original source unknown. The free ulnar artery forearm flap was first described by.
Pedicled and free radial forearm flaps for reconstruction. Department of plastic, reconstructive, aesthetic and hand surgery, university hospital of basel, basel, switzerland. Prior to utilization it must be reversed on its distal pedicle. This chapter talks about free tissue transfer indicated for the replacement of moderate to large soft tissue defects associated with ablative wounds. We report the first use in the uk of an osteocutaneous radial forearm free flap in the reconstruction of a subtotal nasal deficit. The communicating vein and its use in the radial forearm free flap. A subfascial dissection of the radial forearm flap was performed with preservation of the radial nerve b. Preoperative testing for radial forearm free flaps to. Nowadays, the technique for harvesting is standardized, while reconstruction of the forearm.
Squamous cell carcinoma of the tongue is a highly malignant condition. It presents a list of the radial forearm flap layers, and explains the radial forearm flap technique. A radial forearm free flap is one way of filling a hole which is left when a cancer has been removed. The most common free flap used for reconstruction of the scalp was a radial forearm fasciocutaneous free flap 48%, n 28. Some patients will have a tracheotomy, it is more common if having a. Page 2 of 5 your hospital stay after radial forearm free flap surgery uwmc otolaryngology head and neck surgery center box 356161 1959 n. Microvascular surgery protocols general considerations. The radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. The free radial forearm flap fraff delhi head neck. A subcutaneous tunnel was created to access the temporal vessels c. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. Oct 29, 20 micro vascular free flaps used in head and neck reconstruction certified fixed orthodontic courses by indian dental academy 1. Osteocutaneous radial forearm free flap harvest and plating. Radial forearm free flap free download as powerpoint presentation.
The dominant pedicle is the radial artery, with venous outflow through the dual system of the venae comitantes and cephalic vein. The skin of the radial forearm free flap was tubed to recreate the nasal lining and the radial bone reconstructed the dorsal contour of the nose. Optimizing hand and wrist function in the postoperative period may allow more efficient selfcare and return to activities of daily living. The remaining areas were covered with split skin grafts. The skin component of the flap was separated into 3 skin islands based on the clustered perforators.
Chapter 4 the ulnar artery free flap thieme connect. Paniello, md the method of closure of the partial laryngopharyngectomy plp defect can have a profound affect on all three functions of the larynx. Longterm functional donor site morbidity of the free radial. Free radial forearm bunting flap for reconstructing soft.
Radial forearm free flap pharyngoesophageal reconstruction. These structures were covered with a single radial forearm lateral arm mega free flap measuring 44 x 10 cm fig. The skin graft is designed according to the daggershaped technique. The reverse radial forearm rrf flap can be used to cover moderatesized defects. Although associated complications are inevitable in a percentage of patients, it is good. Doctors often use this surgery to reconstruct an area in the head and neck. The skin of the volar forearm provides relatively thin and reliable coverage for a wide variety of defects. Despite its numerous advantages, the radial forearm free flap is.
This document was downloaded for personal use only. The donor site was covered with a fullthickness skin graft. Submental island flap versus radial forearm free flap for oral tongue reconstruction. A single surgeons experience with 67 pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand was analyzed retrospectively. Defects of the soft palate resulting from head and neck oncologic surgery traditionally have been rehabilitated using a prosthetic obturator. Median nerve injury following radial forearm free flap harvest. Among free flaps, the radial forearm free flap rfff has become one of the most commonly used by microvascular surgeons owing to its versatility and the ease of harvesting. Coverage of tendon exposure after radial forearm free flap by. Mcgregor editorial comment postoperatively, the radius must be protected from undue stress because the incidence of fracture can be significant when a segment of the radius has been removed with the flap. The ideal method for buccal defects should provide good outcome of both function and appearance. A crosssectional cohort study at a tertiary care hospital results. The radial forearm free flap rfff is the most commonly used free flap in head and neck reconstructive surgery.
Reliability of the superficial venous drainage of the radial forearm free flaps in oral and maxillofacial reconstruction. Free tissue transfer is the mainstay for reconstruction of large head and neck defects for both benign and malignant disease. Radial forearm free flap for partial laryngopharyngectomy. Pdf salvage of free radial artery forearm flap following. Reconstruction of scalp defects with the radial forearm free flap. Radial forearm versus the ulnar forearm free flap full.
Free radial forearm flap and anterolateral thigh flap for reconstruction of hemiglossectomy defects. Radial forearm free flap in intraoral reconstruction. The reliability of the iberic graft for covering of the. Longterm functional donor site morbidity of the free radial forearm. It can be used to replace large parts of the mouth and. Indian dental academy leader in continuing dental education 2. Harvesting the free radial forearm flap reduces skin perfusion in the fingers of the donor arm and, we assume, leads to a redistribution of blood flow to the fingers, with the residual ulnar artery still supplying more blood flow to finger i than to finger v. To assess the functional donor site morbidity of the forearm free flap. Reducing the donor site morbidity in radial forearm free flaps by. Radial forearm free flap rfff with subjective methods. However, many donor site complications have been described, such as partial loss of the skin graft, sensory disturbance, tendon exposure, and esthetic pitfalls. Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap. If you dont have a registration, then register for.
Pedicled and free radial forearm flaps for reconstruction of the elbow. The harvested radial forearm free flap measured 6 x 12 cm d. Functional reconstruction of subtotal glossectomy defects. The radial artery and accompanying vein in the flap were anastomosed endtoend to. In 1978, a fasciocutaneous free flap from the volar aspect of the forearm and pedicled on the radial artery was first used in china. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects.
Figure 1, followed by a latissimus dorsi muscle free flap and split thickness skin graft 34%, n 20 and rectus abdominis myocutaneous free flap 16%, n 9. Radial forearm free flap what is a radial forearm free flap. Jun 26, 2016 radial forearm free flap in intraoral reconstruction d. The radial forearm free flap was inset in the scalp over a drain using interrupted sutures e. To compare the functional and aesthetic outcomes of radial forearm free flap rfff donor sites reconstructed with fullthickness skin graft ftsg, split thickness skin graft stsg alone, and stsg overlying an acellular dermal matrix alloderm study design and setting. It has since become a work horse for soft tissue replacement in. Nevertheless, while the radial forearm free flap rfff, proposed for. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Prelamination of neourethra with uterine mucosa in radial. Pdf folded free radial forearm flap for reconstruction. The radial forearm free flap rfff was introduced by yang et al. Reverse radial forearm flap to provide arterial inflow to a toe. A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy 2004.
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