The ulnar forearm free flap in penile reconstruction

The case is presented of a young man who suffered a traumatic hind-quarter amputation and penile infarction. One stage penile reconstruction was performed using a free ulnar forearm flap.     

The free ulnar forearm flap

Many flaps have been described based on the septocutaneous perforators; these have many advantages for the coverage of soft tissue defects. The ulnar forearm flap described by Lovie is a septocutaneous flap based on the septocutaneous perforators of the ulnar artery. We report the use of this flap in 2 patients who required soft tissue coverage. The ulnar forearm flap has the advantages of thin and pliable skin, constant and large pedicle, and the technical possibility of combination with the muscles, sensory or motor nerve, and ulna. 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. After skin grafting, the donor scar is unnoticeable because of its position on the forearm. This flap is for the coverage of thin defects that require mobility, such as in the extremities or the intraoral region. It also could be used for the coverage of hand or arm defects as a distally or proximally based island flap, respectively.     

Dorsalis pedis free flap in oromandibular reconstruction

This paper reports the free dorsalis pedis flap as a fasciocutaneous and osteocutaneous flap in oromandibular reconstruction. The authors present a 7-year series of nine patients with squamous cell carcinoma of oral cavity with extensive soft tissue/soft tissue and bone defect in whom this flap was used for intraoral reconstruction. The free fasciocutaneous flap (two neurosensate) was used in eight patients, and in one patient, a free osteocutaneous flap was required. The follow-up period ranged from 2 and 7 years. No ischemic flap complications occurred and a good anatomical and functional reconstruction was achieved in the majority of patients. There was no significant donor area functional disability. One death occurred in the early post-operative period due to multi-organic failure and four deaths in the follow-up period due to recurrence of the oncological disease. The dorsalis pedis free flap was found to be a good alternative tool for reconstruction of the anterior floor of mouth defects (including marginal mandibular defects). This was also used for anterolateral intraoral soft tissue defects. The donor area morbidity is not problem-free, but with good planning and careful flap dissection, it is possible to minimize the sequelae to a very acceptable level.     

The ulnar artery forearm free flap

The ulnar artery forearm flap is a reliable, versatile and convenient fasciocutaneous flap. Based on the ulnar artery distal to the common interosseous branch it may include muscle (FCU) tendon (PL) and bone (ulna). The arterial and venous anatomy allow a flow-through capability and a reversal of flow which permits its use as a distally pedicled island flap. Many of its properties are shared with the radial flap, but the ulnar flap has further advantages. The donor site is virtually hairless, easily closed even when bone is taken, and is less obvious as it lies on the proximal ulnar aspect of the forearm. The ulnar artery is not reconstituted and in 11 cases there has been no clinical evidence of any circulatory, sensory or motor impairment of the hand. The flap is especially useful in intra-oral reconstruction and has been valuable in the lower leg where it may restore deficient distal circulation.     

The iliac crest and the radial forearm flap in vascularized oromandibular reconstruction

Sixty cases (59 patients) of oromandibular reconstruction using vascularized iliac crests were compared with 13 in which radial osteocutaneous flaps were used. These patients were reviewed from the standpoint of cosmetic results and function as well as their operative and postoperative courses. In both groups, the results were generally good. However, revisionary surgery was more frequent in those receiving the iliac crest. This group also had a higher incidence of intraoral wound breakdown and bone exposure. Nevertheless, the sheer size of the iliac crest made it ideal for massive oromandibular defects, just as its natural curvature lent itself to precise replication of the mandible in bone-only reconstructions. Its bulk proved a major obstacle in small composite defects. The radial forearm flap carried thin, pliable, well-vascularized skin that was superior to groin skin for oral lining. Bone gaps of up to 9 cm could be handled with ease, thus making it complementary to the iliac crest over the wide spectrum of mandibular reconstruction.     

前臂游离皮瓣在保存舌功能的半舌再造术中的应用

目的 探讨前臂游离皮瓣在保存舌功能的半舌再造术中的I临床应用.方法 2002年7月至2006年11月,对40例原发灶为舌侧缘且未超过中线的舌癌患者,于舌癌联合根治术同期行吻合血管的前臂游离皮瓣移植修复半舌缺损,部分病例将前臂外侧皮神经与舌神经断端吻合,制备成感觉皮瓣.结果 40例患者伤口均一期愈合,前臂游离皮瓣完全成活.术后随访6个月至4年6个月,平均2年6个月,供、受区均无严重并发症.再造舌外形好,运动协调.吞咽、语音功能接近正常,感觉功能也有不同程度的恢复,临床疗效满意.结论 对于舌癌联合根治术造成的半舌缺损,应用前臂游离皮瓣修复的临床效果满意.重建后的舌功能恢复较为理想.     

Closure of the ulnar forearm free flap donor site using a local radial forearm flap.

Thin, pliable cutaneous flaps with large calibre vessels ideal for microsurgical transfers are major attributes of the reliable forearm fasciocutaneous flaps. A major detriment, however, that must always be considered is the management of the residual donor site deformity. Just as this potential morbidity for small radial forearm free flap donor sites may be minimised by the V-Y advancement of a local ulnar forearm flap, the converse, using a local radial forearm flap for closure of the ulnar forearm free flap donor site, may be efficacious.     

Eye socket reconstruction with free radial forearm flap

Deformity of the orbital region and contraction of the eye socket were encountered in 3 patients who in their infancy underwent exenteration of the orbit and postoperative irradiation for the treatment of retinoblastoma. These major problems were attributed to the less-vascularized cicatricial conjunctiva left in place. To solve these disadvantages, a microvascular technique using a free radial forearm flap was adopted. A large permanent eye socket was achieved and depression deformity of the orbital region was corrected in a one-stage operation. This is, to our knowledge, the first report on the use of a free vascularized skin flap for "malignant contracture" of an anophthalmic eye socket. The excellent cosmetic results of this method are demonstrated.     

Radial forearm free flap for soft palate reconstruction

Defects of the soft palate resulting from head and neck oncologic surgery traditionally have been rehabilitated using a prosthetic obturator. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal competence during speech and swallowing. However, soft palate obturators have several disadvantages. Device stability and retention are impaired in patients who are edentulous. In addition, prosthetic obturators cover large areas of sensate mucosa in the hard palate, maxillary alveolus, and oropharynx, contributing significantly to the loss of sensory feedback from the oral cavity and oropharynx. Considerable evidence suggests that sensory impairment within the oral cavity and pharynx results in impaired mastication, deglutition, and articulation. A minority of patients find palatal obturators to be unsatisfactory, secondary to either inconvenience or device discomfort.     

One stage reconstruction of penis with free forearm flap

One stage reconstruction of the penis using free tissue transfer was performed on a 43-year-old man who had total penectomy for carcinoma of the penis. A free forearm tissue flap was used to reconstruct urethra and for external skin coverage and Jonas silver penile prosthesis was used as a stent. Nutrient vessels (one artery and two veins) were anastomosed with a lateral circumflex femoral artery and two branches of the saphenous veins respectively and the nerve of flap was anastomosed with the pudendal nerve. We believe that this method is functionally and cosmetrically acceptable for reconstructing the penis, although unfortunately extrusion of the prosthesis ensued 63 days after the operation in our case.     

Dual free flap transfer using forearm flap for mandibular reconstruction.

To reconstruct a composite mandibular defect, we have simultaneously transferred a vascularized bone graft or osteocutaneous flap together with a forearm flap. The radial forearm flap, being thin, pliable, and having a long vascular stalk, served as mucosal lining and/or an interpositional flap acting as a vascular bridge. Between 1982 and 1989, we used this procedure in 17 patients with a mandibular defect or deformity which developed following treatment of oral cancer. Our clinical experience has demonstrated that this dual free tissue transfer has many advantages. It is useful for obtaining a good alveolar ridge in patients with a composite mandibular defect. It is applicable in cases where only a single pair of recipient vessels are present and may be useful when the recipient vessels are positioned some distance from the defect.     

游离前臂皮瓣舌再造的临床经验

目的 探讨舌癌根治术应用游离前臂皮瓣施行一期舌再造术的临床效果。方法 随访分析近3年来35例舌鳞癌根治术中应用游离前臂皮瓣施行一期舌再造的结果，总结有关处理经验和教训。结果 术后35例口腔和颈部创面均一期愈合，术后出现血管危象6例，5例抢救成功，1例失败，移植成活率97．2％。随访3个月～2年半，再造舌外形大部分较好，语言和吞咽功能恢复良好。结论 游离前臂皮瓣是舌癌根治术后舌缺损修复的良好材料，通过完善的围手术期处理，可以达到较高的成功率，提高患者的生存质量。     

Combined free fibular osteocutaneous-lateral calcaneal fasciocutaneous flap for reconstruction of composite oromandibular defects

The free fibular osteocutaneous flap is often used in the reconstruction of composite oromandibular defects. In contrast, the lateral calcaneal flap has never been used in oromandibular reconstruction. On the basis of their anatomic continuity, the authors combined the free fibular osteocutaneous flap with the lateral calcaneal skin paddle to obtain 2 adjoining flaps in different anatomic areas with the same vascular axis. The authors report their experience in 3 patients with composite oromandibular defects. In 1 patient without an outer skin defect, only a sensory lateral calcaneal skin paddle with a fibular osseus flap was harvested. The lateral calcaneal flap carried the sural nerve as a sensory flap in 2 patients, and the result was passable. Only 1 patient encountered superficial flap tip necrosis at the lateral calcaneal skin paddle, and recovered well after wound care. In conclusion, a flap with many specific features is a feasible choice for reconstruction of composite oromandibular defects.