Oropharyngeal reconstruction with radial forearm free flap: functional results

OBJECTIVE: The aim of this retrospective study is to evaluate functional results of oral and oropharyngeal reconstructions with radial forearm free flap. MATERIAL AND METHODS: We present our experience with radial forearm free flap for reconstructing oral and oropharyngeal defect between 2000 and 2004. A total of 96 patients were included in this study. We analysed functional results (alimentation, elocution, mouth opening and cosmetic appearance) and researched the potentialy predictive factors of these results (age, comorbidity, preoperative irradiation...; Chi 2 test). RESULTS: The rate of free flap success was 97.9%. Good functional results (normal or quasi normal function) were obtained for alimentation, elocution, mouth opening and cosmetic appearance in respectively 92.6%, 64.9%, 81.9% and 84.1% of cases. Age (p = 0.05), preoperative irradiation (p = 0.005) and T stage (p = 0,02) had a negative effect on elocution, free flap failure on mouth opening (p = 0.03), preoperative irradiation (p = 0.05) and free flap failure (p = 0,02) on cosmetic appearance. CONCLUSION: Radial forearm free flap is considered as the flap of choice for oral and oropharyngeal reconstructions and allows excellent functional results.     

Functional outcomes following palatal reconstruction with a folded radial forearm free flap

Defects of the soft palate often occur after extirpative procedures are performed to treat oropharyngeal cancers. These defects usually result in velopharyngeal insufficiency and an alteration in speech and deglutition. Palatal prostheses have been used to circumvent this problem in the past. Recently, however, folded radial forearmfreeflaps have been introduced for reconstruction of the soft palate to eliminate velopharyngeal insufficiency and the need for a prosthesis. We conducted a study to evaluate pharyngeal and palatal functions following reconstruction of soft-palate defects with radial forearm free flaps in 16 patients who had undergone resection of the soft palate for squamous cell carcinoma. Nine patients had partial soft-palate defects and 7 had total defects. All patients had lateral pharyngeal-wall defects. In addition, 14 patients had defects of the base of the tongue. Patients were followed for 3 to 40 months. Outcome measures were determined according to several parameters, including postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist and an otolaryngologist with a bedside swallowing evaluation and flexible nasopharyngoscopy. Twelve patients underwent videofluoroscopic studies. There was no incidence of flap failure. One patient developed a transient salivary fistula, which resolved with conservative management. Four patients without dysphagia resumed oral intake 2 weeks after surgery. The 12 patients with dysphagia underwent swallowing therapy. Ten of them responded and were able to resume oral intake, while the other 2 required a palatal prosthesis. Overall, 10 patients resumed a normal diet and 4 tolerated a soft diet within 6 weeks. The 2 patients who required a palatal prosthesis were able to take purees. All patients were decannulated, and all were able to speak intelligibly. Speech was hypernasal in 2 patients and hyponasal in 3. We conclude that the folded radial forearm free flap procedure is a useful alternative for reconstruction of palatal and pharyngeal defects. It is safe and effective, and it results in excellent functional outcomes.     

喉全切除前臂桡侧游离皮瓣发音重建

喉全切除后发音重建一直是临床研究的重要课题之一，目前国内外已有众多方法，术后疗效亦各不相同。前臂皮瓣由杨果凡等于1979年8月创用，目前已广泛用于头颈部软组织缺损的修复，成为头颈缺损修复重建应用最多的游离组织瓣。我们将该皮瓣用于喉全切除后发音重建，自2001年10月-2003年1月共完成5例手术，本文对此手术效果、手术操作及一些有关问题进行回顾性分析。     

乳突筋膜及骨膜-骨组织瓣修补鼻中隔穿孔11例报告

目的观察乳突筋膜及骨膜-骨组织瓣修补萎缩性鼻炎鼻中隔穿孔的方法及疗效。方法11例萎缩性鼻炎的鼻中隔穿孔病人,采用乳突部筋膜及骨膜-骨组织瓣修补穿孔,鼻腔黏骨膜下脂肪组织填塞缩小鼻腔。结果随访24~48个月,11例穿孔均修补成功,鼻黏膜干燥好转。结论鼻中隔穿孔合并有萎缩性鼻炎时,应从其他部位取材,乳突部筋膜和骨膜-骨组织获取方便,成活率高,是一种理想的修补材料。     

Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap

OBJECTIVE: This study examines prospectively the functional outcomes of a cohort of patients who had undergone hemiglossectomy and reconstruction with a bilobed radial forearm free flap (RFFF) for oral tongue squamous cell carcinoma. METHODS: Speech and swallowing data were compiled for patients treated for oral tongue cancer with hemiglossectomy and and reconstruction with a bilobed RFFF. The three evaluation periods were preoperative, postoperatively, and postradiation therapy. RESULTS: Eleven patients were included in the study. A significant difference between preoperative and postoperative single-word intelligibility scores was observed. There was no significant difference across any of the evaluation times for sentence intelligibility. Swallowing analysis revealed fewer instances of laryngeal penetration with liquids postoperatively. No significant differences were found in laryngeal penetration with either the pudding or cookie consistencies across any of the evaluation times. There was no incidence of aspiration at any of the evaluation times. There were no significant differences in the number of problems with the oral or oral preparatory phases across any of the evaluation times. The neurotization status of the RFFF had no significant effect on any of the observed speech or swallowing parameters. CONCLUSIONS: The bilobed RFFF provides functional speech and excellent swallowing outcomes in the reconstruction of hemiglossectomy defects.     

Oral cavity reconstruction using the free radial forearm flap

While a number of flaps are available that can "plug the hole" created by the resection of an oral cavity malignancy, the final functional and cosmetic result is often far from satisfactory. The ideal flap for this area should provide a one-stage, reliable reconstruction (regardless of previous surgery or irradiation) with the options of thin pliable skin and/or vascularized bone. Donor-site morbidity must be acceptable. In our experience, the free radial forearm flap best approaches these ideals. Unfortunately, it has received relatively little attention in the otolaryngology literature. The results of using 15 of these flaps to reconstruct 14 oral cavity defects are reported here. Despite the fact that most of the reconstructions were performed in older patients who had undergone irradiation (nine of 14) and previous surgical treatment (ten of 14), there were no flap failures. Hospital stays were short (less than two weeks), cosmetic results were good, and all but one patient had resumed oral intake by the time of hospital discharge. The specific applications and limitations of this flap are emphasized so that the reader can better understand its role in head and neck reconstructive surgery.     

Evaluation of hand circulation before radial forearm free flap surgery

The radial forearm free flap (RFFF) is a versatile flap offering many reconstructive options for head and neck defects. Its low bulk, ease of dissection, and excellent vascularity are among its advantages. Its low flap loss and complication rates offer the best choice for the reconstruction of oral, oropharyngeal, and hypopharyngeal lining. Evaluation of collateral circulation to the hand is important to avoid distal ischemia and donor site morbidity. Pulse oximetry can be used to augment Allen's test to assess collateral supply to the hand. This cost‐neutral technique can be used in routine preoperative screening prior to RFFF surgery. Laryngoscope, 2009     

Functional outcome after partial glossectomy with reconstruction using radial forearm free flap

Objective

The purpose of this study was to investigate the relationship between the radial forearm free flap (RFFF) volume changes and speech and swallowing outcomes.

Methods

The study included 18 subjects with squamous cell carcinoma of the oral tongue.

Results

Average percentage changes in flap volume between 3 and 12 months was 19.2%. Postoperative free flap volume changes were significantly and negatively correlated with the word and sentence intelligibility (Y = −0.338X + 43.641, r² = 0.383, p = 0.006 and Y = −0.246X + 34.322, r² = 0.321, p = 0.014, respectively). A significant positive correlation was also found between word and sentence intelligibility and floor of mouth resected, postoperative irradiation. Postoperative flap volume changes between 3 and 12 months were correlated with reduced posterior bolus movement by tongue (p = 0.002), reduced tongue base to posterior pharyngeal wall contact (p = 0.002), reduced laryngeal elevation (p = 0.005), increased aspiration (p = 0.005), delayed oral (p = 0.010) and pharyngeal transit time (p = 0.011). Floor of mouth resected, tongue base resected, and postoperative irradiation also influenced the swallowing outcomes.

Conclusions

This study shows that postoperative flap volume changes are significantly related to speech and swallowing outcomes in patients undergoing partial glossectomy reconstructed with RFFF.     

Repair of nasal septal perforation with a silicone button

A symptomatic nasal septal perforation is an annoyance to both the patient and the treating physician. Patients complain of a whistling sound on respiration, persistent nasal crusting, occasional odor, and recurrent bouts of epistaxis. Most of the described surgical methods to attempt to close them, are not very successful; they may require more than one surgical procedure, entailing the associated hospitalization, morbidity, etc., and, at best, dubious outcome. The technique I have used for the past few years was first proposed to me by Vernon Gray M.D.;¹ it offers a simple atraumatic office procedure which, has proven to be successful in eliminating the symptoms resulting from a nasal septal perforation. Naturally, the physician should try to determine the underlying cause of the perforation and when practical, treat it. Most cases, however, are due to previous septal surgery or trauma     

Fistula analysis after radial forearm free flap reconstruction of hypopharyngeal defects

Objective/Hypothesis: To evaluate risk factors and management options for fistula formation after hypopharyngeal reconstruction using the radial forearm free flap reconstruction. Study Design: Retrospective cohort study. Methods: Patients undergoing radial forearm free flap for hypopharyngeal reconstruction were retrospectively reviewed. A total of 104 patients underwent this procedure between 2001 and 2007. Fistulas were classified as mild or severe depending on the response to conservative management. Demographics, operative details, pathology, and postoperative course were recorded as the prognostic variables. Univariate analysis and a logistic regression model were used to identify associated factors. Results: Pharyngocutaneous fistula developed in 30 (28.8%) patients. Recurrence, cancer stage, cancer location, type of ablative surgery, and the addition of other oncologic procedures were identified as significant predictors of fistula formation. Fistula significantly increases hospital stay and recipient site complications such as flap survival, infection, and bleeding. Functional results such as diet, deformity, and socialization were also negatively affected by fistula development. One third of the cases responded to conservative management, and 20 cases required a surgical procedure to definitively close the fistulous track. Conclusions: Fistula formation remains a significant cause of morbidity associated with hypopharyngealreconstruction. Postoperative course and successful preventive strategies are discussed.     

Total lower lip and chin reconstruction with radial forearm free flap: A novel approach

Background

The management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip.