Burned ear reconstruction using a prefabricated free radial forearm flap

Postauricular skin, postauricular fascia, temporoparietal fascia (pedicle or free), the free radial forearm flap (fascial or fasciocutaneous), and free lateral arm fascial flap, have been used for burned ear reconstruction reported in the literature. Patients who did not have normal tissue around the ear region, because of severe thermal injuries to the external ear, are not available for draping the costal cartilage framework; these patients require free flaps. The author reports a burned ear reconstruction, using a prefabricated free radial forearm fasciocutaneous flap, included an autogenous costal cartilage framework. In this case, the front and back of the cartilage framework were covered with the skin of the forearm flap. This is the main difference from other techniques in the literature. This flap is valuable for burned ear reconstruction, when local tissue and other free flaps are not available.     

Immediate full-thickness facial defects reconstruction using the radial forearm free flap

Summary The restoration of composite tissue defects of the oral cavity involving skin and mucosa remains a difficult problem for reconstructive surgeons. A method for immediate one-stage reconstruction of combined intraoral and facial defects with the radial forearm free flap is described. Four patients operated on between July and December of 1991 for advanced squamous cell carcinoma of oral cavity involving oral mucosa, skin and in two cases the mandible were reconstructed with a radial forearm flap to obtain reconstruction of facial and intraoral mucosa. The area of the fold is deepithelialized to be sutured to adjacent tissue.     

Phalloplasty using the free radial forearm flap

Our experience of phalloplasty using the radial forearm flap in five transsexual cases is reported. The results are disappointing due to the high incidence of complications. We had partial success in two cases, both complicated by a fistula, and complete failure in three cases due to vascular thrombosis.     

The radial forearm island flap in upper limb reconstruction

The radial forearm island flap may be used for resurfacing areas of skin in the upper limb. It allows a safe one stage reconstruction of skin loss providing thin, pliable and innervated skin cover. We present five cases which demonstrate the versatility of the flap.     

Transoral reconstruction of the mobile tongue,using radial forearm free flap

Tongue resection has significant influence on the patient's quality of life, because it interferes with masticatory and speech functions and affects facial aesthetics. To avoid the disadvantages of the traditional lip-splitting used to approach partial tongue reconstruction for resection (40% of the tongue or more), we recommend a completely transoral approach, with the radial forearm free flap as a donor flap. Between 1999-2001, the suggested technique was applied in 11 patients with squamous-cell carcinoma of the mobile tongue. A follow-up of 6-30 months showed good to excellent oral function, with preservation of tongue volume, motion, and facial aesthetics. This approach seems to be preferable over the lip-split approach for the reconstruction of mobile tongue defects.     

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.     

Mandibular reconstruction using osteocutaneous radial forearm flap

Objective: To describe the use of radial forearm osteocutaneous free flap in complex mandibular reconstruction. Study Design: A case series. Place and Duration of Study: Combined Military Hospital, Rawalpindi, from January 1998 to January 2008. Methodology: Patients having a small bony component and a large soft tissue mandibular defect requiring reconstruction were selected. These defects include composite through-and-through defects of the cheek in the retromolar trigone, small lateral bony defects with large intra and extra oral soft tissue defects and small central bony defects with large extra oral tissue loss. Radial forearm osteocutaneous free flap was employed. Complications and graft acceptance were determined at follow-up. Results: Patients were followed-up for an average period of 28 months. Complications occurred in 8 patients. Wound infection and partial wound dehiscence were the most common complication observed in 3 patients. Non-union at recipient site was seen in 2 patients. Flap donor site healed uneventfully in all patients with no fractures at the donor site. Conclusion: The radial forearm osteocutaneous flap covers oromandibular defects with large intra-oral and extra oral soft tissue losses. Lateral and anterior mandibular defects were reconstructed satisfactorily in our series.     

Partial thumb reconstruction using the proximal skin paddle radial artery island flap

Four cases of partial thumb reconstruction using the radial artery island flap are presented. The flap will provide in variable amounts all the elements required for reconstruction of a severely damaged thumb.     

Pharyngostome closure using the radial forearm free flap

A technique is described using the radial forearm free flap for pharyngostome closure. The flap may be used in combination with local flaps for external cover only or may be raised as a double paddle for external and internal lining.     

Prelaminated free radial forearm flap for a total nasal reconstruction.

A prelaminated osteocutaneous radial forearm flap has previously been described for total nasal reconstruction, but achieving good aesthetics at the dorsum and tip tends to be difficult with a flap that can be too bulky. We present a case of total nasal reconstruction in a burns patient where a tight adherent scar at the forehead precluded the use of a forehead flap, ideal for such reconstructions. We successfully used a prelaminated free radial forearm flap, with a non-vascularised bone graft. The existing scarred skin at the dorsum was turned down as pedicled flaps for the lining. We were able to achieve a successful total nasal reconstruction which was aesthetically pleasing and made a tremendous impact on the quality of life of the patient.     

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.     

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.     

Microsurgical penile reconstruction with a sensitive radial forearm free flap

A series of six consecutive cases of total penile reconstruction with a sensitive forearm free flap based on the radial artery is presented. A simple, reliable, and easily reproducible technique with an acceptable aesthetic appearance is described. No partial or complete flap losses were found. The only complication found in three patients was a urinary fistula on the distal third of the flap, which was repaired successfully with a secondary surgical procedure. The aesthetic and functional outcome was satisfactory to the patient and surgical team in all cases. A sensitive radial forearm free flap is a good choice of treatment for total penile reconstruction.     

Full-thickness cheek and lip reconstruction with the radial forearm free flap

The radial forearm free flap has proven versatility in head and neck reconstruction. It is superior to regional alternatives such as the pectoralis flap because it is thin, pliable, and predominantly hairless. A more recent application is the use of the folded forearm flap to replace both the skin and inner lining, simultaneously, in full-thickness cheek and lip defects. Nine such cases are presented in this report. Each patient had a recurrent lesion that had been reconstructed previously with local flaps, and all but one were treated with postoperative radiation therapy. The average size of the external defects after resection was 27 cm2, and of the intraoral defects, 18 cm2. All free flaps survived completely. The folded forearm flap solved the reconstructive problem for each patient in a single-stage procedure, providing good contour and a reasonable color match. The flap is easy to raise, has a long pedicle with large-diameter vessels, and has an acceptable donor site defect not associated with long-term morbidity.     

Complications of free radial forearm flap transfers for head and neck reconstruction.

Free tissue transfer using microvascular anastomosis has been established as an accepted maxillofacial reconstructive procedure. The free radial forearm flap (FRFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. Since 1992, we have carried out 38 FRFF transfers in 37 patients for reconstruction after head and neck cancer ablative surgery. We present our clinical experience with head and neck reconstruction using the FRFF and the morbidity of the donor sites. Of the 38 FRFFs, 35 FRFFs were performed successfully. The survival rate of FRFF was 92%. Donor site complications included partial loss of skin graft in 4 donor sites (11%), abnormal sensations in 10 (26%), poor appearance in 3 (8%), and reduced grip strength in 4 (11%). Therefore, we believe that, because of the reliability, functional characteristics, and low donor site morbidity, the FRFF is a useful and versatile flap for reconstruction of head and neck defects.     

Digital reconstruction using the distally based osteofasciocutaneous radial forearm flap

The Chinese forearm flap is a versatile flap in hand reconstruction. Five cases are reported. The mechanism and reliability of retrograde venous return is discussed.     

Total nasal reconstruction using a prelaminated free radial forearm flap and porous polyethylene implants

Reconstruction of total nasal defects remains one of the most difficult problems in plastic surgery as the nose combines aesthetics and function. Standard techniques using either forehead or nasolabial flaps do not have a place in the case of extensive scarring on the face or areas with high risk of cancer recurrence on the face. In these cases, microsurgical free tissue transfer for the soft tissue reconstruction in combination with bone grafts or implants for the nasal skeleton are ideal. We report the use of prelaminated radial forearm flap with porous polyethylene implants for total nasal reconstruction.