Skip to main content

Advertisement

SpringerLink
Log in

Osteocutaneous Radial Forearm Flaps for Mandibular Reconstruction

  • Head and Neck Reconstruction (E Rosenthal, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The radial forearm free flap has been the mainstay of soft tissue reconstruction for composite defects after tumor ablation in the head and neck. On an anatomic basis, the flap also has the potential to be harvested with a boney component. Up to half of the radial forearm bone can be harvested and included in the flap. This allows the flap to be used not only for composite soft tissue defects but for composite boney defects.

Material & Methods

A literature review was performed of articles published in the last 10 years.

Recent Findings

When first described, the incidence of radial fracture was unacceptable. This led to most surgeons advocating other reconstructive methods. However, innovations in management of the osteotomy site have decreased the incidence of fracture to almost zero. The morbidity of the harvest site is the same as for the soft tissue flap. The functional reconstruction has been shown to be as good as other boney flaps for the selected defects.

Summary

This manuscript describes the innovations and results that have occurred with the radial forearm osteocutaneous free flap in the last decade.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yang GF, Chen PJ, Gao YZ, et al. Forearm free skin flap transplantation: a report of 56 cases. Br J Plast Surg. 1997;50:162–5.

    Article  CAS  PubMed  Google Scholar 

  2. •• Dean NR, et al. Free flap reconstruction of lateral mandibular defects: indications and outcomes. Otolaryngol Head Neck Surg. 2012;146(4):547–52. This manuscript compared lateral mandibular reconstruction by fibula flaps with radial osteocutaneous flaps. No difference in complication rates or postoperative outcomes was seen between groups (P > .05).

  3. Inglefield CJ, Kolhe PS. Fracture of the radial forearm osteocutaneous donor site. Ann Plast Surg. 1994;33(6):638–42.

    Article  CAS  PubMed  Google Scholar 

  4. Thoma A, et al. Oromandibular reconstruction with the radial forearm osteocutaneous flap: experience with 60 consecutive cases. Plast Reconstr Surg. 1999;104:368–78.

    Article  CAS  PubMed  Google Scholar 

  5. Sinclair CF, et al. Assessment of donor site morbidity for free radial forearm osteocutaneous flaps. Microsurgery. 2012;32(4):255–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Arganbright JM, et al. Outcomes of the osteocutaneous radial forearm free flak for mandibular reconstruction. JAMA Otolaryngol Head Neck Surg. 2013;139(2):168–72.

    Article  PubMed  Google Scholar 

  7. •• Silverman DA, et al. Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: an 8-year review of complications and flap survival. Head Neck. 2016;38(3):434–8. This manuscript looked at the complications in radial forearm osteocutaneous flaps evaluating length and number of osteotomies. Complication rates were only slightly higher when the bone length was ≥7 cm or when multiple osteotomies were required.

  8. Jaquet Y, Enepekides DJ, Torgerson C, Higgens KM. Radial forearm free flap donor site morbidity: ulnar-based transposition flap vs split-thickness skin graft. Arch Otolaryngol Head Neck Surg. 2012;138:38–43.

    Article  PubMed  Google Scholar 

  9. Giordano L, Bondi S, Ferrario F, Fabiano B, Bussi M. Radial forearm free flap surgery: a modified skin-closure technique improving donor-site aesthetic appearance. Acta Otorhinolaryngol Ital. 2012;32:158–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. De Bree R, et al. Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap. Laryngoscope. 2004;114:1973–6.

    Article  PubMed  Google Scholar 

  11. • Orlik JR, et al. Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors. J Otolaryngol Head Neck Surg. 2014;43:1 (2014). The authors assessed the morbidity of a radial forearm osteocutaneous flap in 2 year survivors. There was significant decrease in function that was well tolerated by survivors.

  12. Sinha UK, Shih C, Chang K, Rice DH. Use of AlloDerm for coverage of radial forearm free flap donor site. Laryngoscope. 2002;112:230–4.

    Article  PubMed  Google Scholar 

  13. Wester JL, Pittman AL, Lindau RH, Wax MK. AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg. 2014;150:47–52.

    Article  PubMed  Google Scholar 

  14. Zuidam JM, Coert JH, Hofer SOP. Closure of the donor site of the free radial forearm flap: a comparison of full-thickness graft and split-thickness skin graft. Ann Plast Surg. 2005;55:612–6.

    Article  CAS  PubMed  Google Scholar 

  15. Olson MD, Moore EJ, Price DL. Removal of the split thickness skin graft from the skin paddle of the donor site: a single institution’s experience. Am J Otolaryngol. 2015;36(6):820–2.

    Article  PubMed  Google Scholar 

  16. Ghanem TA, Wax MK. A novel split thickness skin graft donor site: the radial skin paddle. Otolaryngol Head Neck Surg. 2009;141(3):390–4.

    Article  PubMed  Google Scholar 

  17. Elliot D, Bardsley AF, Batchelor AG, Soutar DS. Direct closure of the radial forearm flap donor defect. Br J Plast Surg. 1988;41:358–60.

    Article  CAS  PubMed  Google Scholar 

  18. Winslow CP, Hansen J, Mackenzie D, Cohen JI, Wax MK. Pursestring closure of radial forearm fasciocutaneous donor sites. Laryngoscope. 2000;110:1815–8.

    Article  CAS  PubMed  Google Scholar 

  19. Virgin FW, Iseli TA, Iseli CE, Sunde J, Carroll WR, Magnuson JS, Rosenthal EL. Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects. Laryngoscope. 2010;120(4):663–7. doi:10.1002/lary.20791.

    Article  PubMed  Google Scholar 

  20. Gonzalez-Castro J, Petrisor D, Ballard D, Wax MK. The double-barreled radial forearm osteocutaneous free flap. Laryngoscope. 2016;126(2):340–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code PV-01, Portland, OR, 97239, USA

    Mark K. Wax

Authors
  1. Mark K. Wax
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark K. Wax.

Ethics declarations

Conflict of Interest

Dr. Mark Wax declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Head and Neck Reconstruction.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wax, M.K. Osteocutaneous Radial Forearm Flaps for Mandibular Reconstruction. Curr Otorhinolaryngol Rep 4, 189–193 (2016). https://doi.org/10.1007/s40136-016-0127-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-016-0127-z

Keywords

Search

Navigation