Because of the ease of flap elevation, the radial forearm flap. 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. Defects of the soft palate resulting from head and neck oncologic surgery traditionally have been rehabilitated using a prosthetic obturator. Mandibular reconstruction using osteocutaneous radial. Free radial artery forearm flap in reconstruction of oral. Versatility of radial forearm free flap for intraoral. 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. Radial forearm free flap phalloplasty is the most commonly performed flap for neophallus construction in the femaletomale ftm transgender patient.
Ct scan performed one month after surgery showing patent airway and costal cartilage graft. 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. The patient did not complain about the appearance and function of the left forearm. The radial forearm free flap was inset, and the radial artery and cephalic veins were anastomosed to the right superior thyroid artery and external jugular vein, respectively. Objective the aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. Page 1 of 5 your hospital stay after radial forearm free flap surgery uwmc otolaryngology head and neck surgery center box 356161 1959 n.
This chapter talks about free tissue transfer indicated for the replacement of moderate to large soft tissue defects associated with ablative wounds. It has since become a work horse for soft tissue replacement in. Objective the aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to. Pdf described in 1981 by the chinese authors yang kuofan et al.
In 1978, a fasciocutaneous free flap from the volar aspect of the forearm and pedicled on the radial artery was first used in china. Understand the relevant anatomy associated with this procedure. Radial forearm flap british association of oral and. It is ideally suited where complex patterns and designs are required and it is a relatively easy flap to manipulate in a variety of different dimensions. It has since become a workhorse for soft tissue replacement in head. A rare case of a normal preoperative arteriogram and acute intraoperative hand ischemia. Harvesting of free radial artery forearm flap fraff. Learn about the free radial forearm flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. A rare case of a normal preoperative arteriogram and acute intraoperative hand ischemia terrence w bruner md mba1, matthew m hanasono md2, roman j skoracki md2 1university medical group, greenville hospital system, greenville, south carolina. Revisiting radial forearm free flap for successful venous drainage.
The radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Osseocutaneous radial forearm free tissue transfer for. Flap raising is possible simultaneous to tumor resection in the head and neck area and can be carried out quickly. Management of the radial forearm free flap donor site with.
Urological complications, however, can arise quite frequently and can prevent the patient from urinating in the standing position, an important postsurgical goal for many. When your condition is stable and there is a room available, you will move to. Clinical reliability of radial forearm free flap in repair. The skin of the volar forearm provides relatively thin and reliable coverage for a wide variety of defects. Radial forearm free flap is regularly used in reconstruction of oral and maxillofacial region after ablative cancer surgeries. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal. It presents a list of the radial forearm flap layers, and explains the radial forearm flap technique. We analyzed the superiority and reliability of the flap. Used as an island flap, the pitfalls of the microsurgical procedures required for a free. Chinese flap, is a free flap technique that was developed by dr yang goufan, dr chen baoqui and dr gao yuzhi of.
Revisiting radial forearm free flap for successful venous drainage yong hoon cha, woong nam, inho cha and hyung jun kim abstract tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly dependent on venous drainage. Free radial artery forearm flap in reconstruction of oral cavity cancers our experience 88 int j res med. Based on this study, when used for a minimum of 6 days, the vac bolster dressing eliminated tendon exposure at the forearm donor site. Radial forearm free flap for soft palate reconstruction. A fullthickness paramedian forehead flap supplied external coverage. Endoscopic adipofascial radial forearm flap reconstruction o. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Your hospital stay after radial forearm free flap surgery. Radial free forearm flap rfff surgical technique vula. Osseocutaneous radial forearm free tissue transfer for repair.
Harii described the use of a tubed fasciocutaneous free flap for pharyngoesophageal reconstruction in 1985. In the cpt for skindeep tissue flaps 15xxx, it states a repair of a donor site required a skin graft or local flaps is considered an. The flap can be made sensate by inclusion of either the medial or lateral cutaneous nerves of the forearm. Tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly. 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. Radial forearm flap an overview sciencedirect topics. The dominant pedicle is the radial artery, with venous outflow through the dual system of the venae comitantes and cephalic vein. A radial forearm free flap is one way of filling a hole which is left when a cancer has been removed. Haemodynamic changes in the fingers after free radial. Prelamination of neourethra with uterine mucosa in radial. The purposes of this study were to propose a means to decrease the rate of pathological fracture by prophylactic fixation of the donorsite.
Tracheal reconstruction with radial forearm free flap and. Using mucosa to construct the fixed urethra and to prelaminate the penile. Transoral reconstruction of the mobile tongue, using radial forearm free flap. 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. Radial forearm free flap what is a radial forearm free flap.
The flap was transferred, like bunting, to the injured hand with an exteriorized pedicle. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal competence during speech and swallowing. A, postoperative appearance 5 years after a radial forearm free flap donor site. Osteocutaneous radial forearm free flaps have fallen from favor due to pathological fractures of the radius. B trachea after reconstruction with radial forearm free flap. Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. It is most often designed as a free flap but may be pedicled e. Despite the increasing development of thin perforator flaps and continuous sophistication of flapraising techniques at nearly any donor site of the body, the rff remains the most commonly used free flap, mostly raised as a standard fasciocutaneous. Pdf folded free radial forearm flap for reconstruction of. Clinical reliability of radial forearm free flap in repair of. Objective to evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous radial forearm free flap ocrfff used for midface reconstruction. Radial forearm free flap free download as powerpoint presentation. This study demonstrates that the vac system is a feasible alternative to conventional bolster dressing in the management of the radial forearm free flap skin. 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.
Pdf folded free radial forearm flap for reconstruction. When this socalled chinese flap was originally described by yang et al. 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. The use of a prefabricated radial forearm free flap for.
The chinese forearm flap is vascularized by the radial artery and may be used as an island or a free flap. Radial forearm free flap atlas of operative oral and. Radial forearm free flap iowa head and neck protocols. He then does a skin graft on the donor site for closure. Since its first description in 1981, the radial forearm free flap has become a valuable tool for reconstructive microsurgery. Submental island flap versus radial forearm free flap for. The radial forearm free flap rfff has been widely used as a reliable reconstructive solution as it provides thin soft tissues, particularly useful to reconstruct the oral cavity and other head. Free radial forearm bunting flap for reconstructing softt. Longterm functional donor site morbidity of the free. Some patients will have a tracheotomy, it is more common if having a. It must be a unicortical block of volar radius, and no wider than 1.
Surgical technique ottie van zyl the radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. 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. This piece of writing comprised all the detail about harvesting radial forearm free flap, advantages, disadvantages. We present a case of endonasal free tissue transfer reconstruction of a clival radionecrosis defect with an adipofascial radial forearm free tissue transfer, detailing the reconstructive techniques to overcome the challenges of endonasal flap inset.
Mri performed 21 months after surgery demonstrating stability of the radial forearm free flap and costal cartilage construct with no evidence. Radial forearm versus the ulnar forearm free flap full. Submental island flap versus radial forearm free flap for oral tongue reconstruction. Indications the forearm flap has been used for just about everything imaginable in the area of head and neck reconstruction. The radial forearm flap is a very versatile flap and is at its best as a cutaneous flap. Postoperative sagittal cect b following base of tongue hemiglossectomy and laryngopharyngectomy shows the radial forearm ff reconstruction long arrow. Cpt 20969 radial forearm free flap medical billing and. Osteocutaneous radial forearm free flap in subtotal nasal. This study involved nine longterm survivors 2 year postoperative who had forearm free flaps to reconstruct head and neck defects. 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. Squamous cell carcinoma of the tongue is a highly malignant condition. The diagram a shows that free flaps can be partially rolled upper right or completed tubed lower right to reconstruct the upper aerodigestive tract.
Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal. Revisiting radial forearm free flap for successful venous. We report the first use in the uk of an osteocutaneous radial forearm free flap in the reconstruction of a subtotal nasal deficit. Nowadays, the technique for harvesting is standardized, while reconstruction of the forearm donor site defect is somewhat controversial. Download as an information leaflet pdf radial forearm flap. Tracheal reconstruction with the use of radial forearm free. Radial forearm free flap pharyngoesophageal reconstruction.
Introduction the radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. It is one of the most common ways of replacing tissue in the head and neck, particularly after mouth cancers have been removed. The flap is based on the axis of the radial artery. Free radial forearm bunting flap for reconstructing soft. 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.
Mandibular reconstruction using osteocutaneous radial forearm. Microvascular surgery protocols general considerations. Page 2 of 5 your hospital stay after radial forearm free flap surgery uwmc otolaryngology head and neck surgery center box 356161 1959 n. The radial forearm free flap is a popular reconstructive flap in modern head and neck surgery. Pdf transoral reconstruction of the mobile tongue, using. Free tissue transfer is the mainstay for reconstruction of large head and neck defects for both benign and malignant disease. Radial forearm free flap musculoskeletal system medicine. The radial forearm free flap and the ulnar forearm free flap are both welldescribed procedures used for free tissue transfer in reconstructive surgery.
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. Free flaps did not, however, become widely used for hypopharyngeal reconstruction until after the refinement of microvascular techniques during the 1970s. Median nerve injury following radial forearm free flap harvest. Radial forearm free flap postoperative instructions. The radial forearm flap is supplied by the radial artery and perforators from the radial artery to the overlying. Poor wound healing at the forearm donor site is common and frequently results in tendon exposure. The radial forearm flap journal of plastic, reconstructive. Nov 22, 2011 radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Doctors often use this surgery to reconstruct an area in the head and neck. With the introduction of the radial forearm flap by song, plastic surgeons were quick to realize its potential in head and neck reconstruction. Tracheal reconstruction with the use of radial forearm. Endoscopic adipofascial radial forearm flap reconstruction. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects.
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