Reconstruction of the trachea with a tubed radial forearm free flap

BACKGROUND: We present the case of a patient with adenoid cystic carcinoma of the trachea who had 60 mm of the trachea excised and reconstructed with a stented radial forearm free flap. The patient was well in the immediate postoperative period with good function of the neotrachea. Problems developing after the reconstruction included proximal stricture, sputum retention, and recurrent pneumonia. RESULT: The patient died of malignant hypercalcemia 16 months after the reconstruction. To our knowledge this is the first reported case of a total tracheal resection and reconstruction with a combination of free tissue transfer and internal stenting. CONCLUSION: We conclude that tracheal reconstruction has the potential to provide a reliable airway in patients not able to be reconstructed with a primary anastomosis.     

Reconstruction of the penis using a radial forearm free flap. A case report

The total reconstruction of a penis using an innervated radial forearm osteofasciocutaneous free flap is described. Essentially, this procedure is completed in a single stage and satisfies all criteria for good penis reconstruction: the urethra opens at the distal end of the shaft allowing normal micturition; and sensory innervation of the flap, together with the inclusion of vascularised autogenous bone as a stiffener, facilitates normal sexual function.     

Reconstruction of the hard palate using the radial forearm free flap: indications and outcomes

BACKGROUND: Although prosthetic obturation is the "gold standard" for restoration of hard-palate defects, obturators can be problematic. We present 10 cases of palatal reconstruction with the radial forearm free flap and compare patient satisfaction with defect-matched patients rehabilitated with prosthetic obturation. METHODS: Twelve patients who underwent radial forearm free flap (RFFF) reconstruction of a hard-palate defect and eight patients, with similar-sized defects who were rehabilitated with a prosthetic obturator, were evaluated for donor site and recipient site complications, diet, and patient satisfaction. RESULTS: All the patients in both groups were able to resume an unrestricted diet with normal mastication and articulation. Both groups achieved equivalent satisfaction scores with regard to appearance, chewing, and taste; however, the patients reconstructed with an RFFF reported higher satisfaction scores in speech, comfort, convenience, and social interaction. CONCLUSIONS: RFFF reconstruction of hard-palate defects provides a functional alternative to conventional prosthetic obturators.     

Reconstruction of oropharyngeal defects utilizing a free radial forearm flap

The authors report their experience with free radial forearm flaps for oropharyngeal reconstruction. Fifteen patients who submitted to intraoral reconstruction with this flap were followed for periods ranging from 3 to 36 months, with a mean of 14 months. Ages ranged from 15 to 58 years with a mean of 41. The defects were secondary to tumor ablation (11 patients), complications of conventional treatment for congenital deformities (3 patients) and trauma resulting from a gunshot wound to the upper lip and palate (1 patient). Total necrosis of 1 flap occurred and 1 patients required reoperation on the first postoperativeday for revisionof the anastomoses. Our results enable us to recommend the radial forearm flap as the flap of choice for reconstruction of extensive oropharyngeal defects. © 1994 Wiley-Liss, Inc.     

Second free radial forearm flap for urethral reconstruction after partial flap necrosis of tube‐in‐tube phalloplasty with radial forearm flap: A report of two cases

We present a salvage procedure to reconstruct the neo‐urethra after partial flap necrosis occurring in free radial forearm flap (RFF) phalloplasty for sex reassignment surgery. Two cases of tube‐in‐tube phalloplasty using a free sensate RFF are described in which partial flap necrosis occurred involving the complete length of the neo‐urethra and a strip of the outer lining of the neo‐phallus. Neo‐urethra‐reconstruction was performed with a second RFF from the contralateral side providing well‐vascularized tissue. No flap‐related complications were observed. Twelve months postoperatively, both patients were able to void while standing. A satisfactory aesthetic appearance of the neo‐phallus could be preserved with an excellent tactile and erogenous sensitivity. Using this technique, we successfully salvaged the neo‐urethra and reconstructed the outer lining of the neo‐phallus © 2013 Wiley Periodicals, Inc. Microsurgery 34:58–63, 2013.     

应用前臂游离皮瓣折叠法修复大型腭部洞穿性缺损

目的 探讨大型腭部洞穿性缺损修复的方法.方法 2003年至2006年,我们应用前臂游离皮瓣折叠法为7例患者进行了腭部洞穿性缺损修复,共使用皮瓣8块,其中前臂游离皮瓣7块,胸大肌岛状瓣1块.结果 除1例前臂游离皮瓣因动脉栓塞失败外,其余组织瓣完全成活,再造腭部形态良好.患者可经口腔正常进食,并进行基本正常的语言交流.结论 利用前臂游离皮瓣折叠法进行大型腭部洞穿性缺损的修复,是一种有效可行的方法.     

Forehead reconstruction with a modified radial forearm flap: a case report

Forehead reconstruction, using a radial forearm flap with opposing long arterial and venous pedicles, is presented. Advantages of this flap design are discussed.     

Reconstruction of maxillary and palatal defects with the free radial forearm flap

We present six patients with maxillary and palate defects that were reconstructed with the radial forearm flap. Four patients had malignant neoplasms involving the maxilla, three with squamous cell carcinoma and the fourth with recurrent basal cell carcinoma. They were treated with excision and immediate reconstruction using a radial forearm free flap. The other two patients presented with large fistulae between the maxilla and nasal sinuses, these being sequelae of previous surgical treatment for malignancies. The fistulae were closed with radial forearm free flaps. This method provides primary wound healing, restoration of palatal function, preservation of facial contour, and a minimal morbidity while obviating the need for palatal prosthesis. In the six cases, the oral cavity has been completely separated from the paranasal sinus and nasal cavity, and all patients demonstrated satisfactory deglutition and intelligible speech.     

The distally-based radial forearm free flap with valvulotomy of the cephalic vein; a preliminary report

The radial forearm free flap is widely used in microsurgical reconstruction where a thin, hairless flap is required. While the radial artery may be based either proximally or distally, the venous drainage is generally proximally based in order to provide normal flow through the valves. We have utilised this flap in two patients, based distally on both the radial artery and cephalic vein by removing the valves of the cephalic vein. This technique has been employed widely in peripheral vascular surgery of the lower limb and is called the "in-situ" technique. We have found it to be efficacious in taking a proximal skin paddle, which decreases donor site morbidity and allows for a long vascular pedicle. This paper reports on these two patients and describes the technique of valvulotomy of the cephalic vein.     

The radial forearm flap

Described in 1981 by the Chinese authors Yang Kuofan et al. [1] as a free flap, then in 1982 by Lu et al. [2] as a retrograde flow pedicle flap, this fasciocutaneous flap is designed at the level of the anterior and external faces of the forearm, and vascularized by the radial artery via a network of septal arteries. Prior to utilization it must be reversed on its distal pedicle. This flap allows repairing cutaneous substance loss of the whole hand and fingers. The emergence of the Chinese flap in the 1980’s resulted in a regression of the Mac Gregor groin flap that was widely used at this time [3,4]. Nevertheless, other forearm flaps, less “expensive” in terms of vascular involvement [5–9] have reduced its indications. The Chinese flap however keeps two essential indications: the multi-finger important defect that no other forearmflapmay cover; and composite substance loss of the thumb (despite the fact that the Chinese flap shares these indications with interosseous artery composite flaps).     

Intraoral anastomosis of a prelaminated radial forearm flap in reconstruction of a large persistent cleft palate

In this report, we present a case of a prelaminated radial forearm flap in reconstruction of a large persistent cleft palate with transoral single arterial and three venous anastomoses. A 17‐years‐old female patient presented a large cleft palate defect and complete dentition, dysmelia of both arms and bilateral thumb aplasia. A radial flap was prelaminated using oral mucosa 5 days prior to transplantation. Five days after flap prelamination, the facial artery and vein, submandibular vein, and a venous branch to the masseter muscle behind the buccinator muscle fibers were exposed through an intraoral incision lateral to the inferior right mucogingival junction. The radial artery, its bilateral accompanying veins, and the cephalic vein of transplanted flap were anastomosed transorally to the facial vessels, submandibular vein, and masseter branch. The vessel pedicle ran through the palatoglossal arch dorsal to the second upper molar. Good flow and flap perfusion were evinced, and further‐on successful healing was achieved. The case encourages similar treatment in comparable situations avoiding facial nerve hazard and extraoral scars. © 2013 Wiley Periodicals, Inc. Microsurgery 34:229–232, 2014.     

The shamrock flap: a three-paddle radial forearm flap

The radial forearm flap has been well described for reconstruction of the oral cavity. The flap is most commonly used as a single-paddle flap with or without a segment of vascularised radius. Double-paddle radial flaps may be required to reconstruct defects of intraoral lining and overlying skin following excision of extensive tumours. We wish to report the first described case of reconstruction using a triple-paddle radial forearm flap including a segment of vascularised radius.     

Hypothenar hammer syndrome after radial forearm flap harvest: a case report

A case of acute hypothenar hammer syndrome (HHS) in a high-risk laborer in whom the radial artery had been surgically removed during a prior radial forearm flap harvest is reported. Studies estimating the true incidence of HHS among laborers are reviewed to define the risk of this complication. Two major risk factors must be considered in the assessment of a patient for radial forearm flap harvest. First, the risk for immediate vascular compromise is determined by using a standard Allen's test to assess ulnar artery contribution to hand perfusion. Second, the risk for future vascular compromise is determined. When patients at high risk for HHS are recognized the surgeon should consider other reconstructive alternatives. If the superficial palmar arch is patent and complete and a radial forearm flap is performed, postoperative activity modification and risk counseling should be provided.     

Longitudinally-split radial forearm flap.

We have applied the split flap concept to a distally-pedicled radial forearm flap to cover separate dorsal defects of the fingers in two cases. The rationale is that there are the vascular plexuses inside and around the sensory nerve that permit surgical splitting of the flap. In the split design, the first segment is supplied by the radial artery itself. The second segment is supplied by the neurocutaneous artery of the medial cutaneous nerve.