Skip to main content

Advertisement

SpringerLink
Log in

Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The radial forearm free flap (RFFF) is commonly used in reconstructive surgery. With respect to the maxillofacial region, several venous anastomotic techniques (e.g., single or double anastomoses) have been described, but the debate as to which alternative is preferable is ongoing. A complicating factor is the unpredictable anatomical situation in patients undergoing secondary operation. No recommendations are available for the surgical strategy in such cases. We present a standard operating procedure (SOP) applicable for secondary reconstructions, postulating double anastomoses as the method of choice, and evaluate its efficacy.

Methods

The following parameters were retrospectively analyzed for 120 patients with secondary (41; 34.2%) or primary (79; 65.8%) reconstruction following the instructions of SOP and compared between the study groups: age; sex; history of radiotherapy; side of the donor arm; flap size; preparation and use of the cephalic vein and reasons for its non-inclusion; included venae comitantes; recipient veins; arterial anastomoses; revisions, flap survival, and mortality within thirty days after operation.

Results

The method of choice was applicable in 26 (63.4%) secondary and 52 (65.8%) primary reconstructions (no difference; P = 0.841), resulting in 100% flap viability in both groups. In the remaining cases, single venous anastomoses were performed, resulting in 73.3% flap viability in secondary and 100% in primary reconstructions. Flap survival in secondary reconstructions was significantly higher when double anastomoses were conducted (P = 0.012).

Conclusions

The results suggest the necessity of double venous anastomoses in secondary maxillofacial reconstructions with RFFF.

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

  1. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109:2219–26; discussion 2227-30.

    Article  PubMed  Google Scholar 

  2. Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 1993;92:421–8; discussion 429-30.

    Article  PubMed  CAS  Google Scholar 

  3. Valentini V, Cassoni A, Marianetti TM, Battisti A, Terenzi V, Ianetti G. Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap? J Craniofac Surg. 2008;19:1148–53.

    Article  PubMed  Google Scholar 

  4. Marques Faria JC, Rodrigues ML, Scopel GP, Kowalski LP, Ferreira MC. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg. 2008;61:172–9.

    Article  PubMed  Google Scholar 

  5. Futran ND, Gal TJ, Farwell DG. Radial forearm free flap. Oral Maxillofac Surg Clin North Am. 2003;15:577–91, vi–vii.

    Google Scholar 

  6. Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck. 2010;32:1236–45.

    Article  PubMed  Google Scholar 

  7. Jacobson MC, Franssen E, Fliss DM, Birt BD, Gilbert RW. Free forearm flap in oral reconstruction. Functional outcome. Arch Otolaryngol Head Neck Surg. 1995;121:959-64.

    PubMed  CAS  Google Scholar 

  8. Timmons MJ, Missotten FE, Poole MD, Davies DM. Complications of radial forearm flap donor sites. Br J Plast Surg. 1986;39:176–8.

    Article  PubMed  CAS  Google Scholar 

  9. Dassonville O, Poissonnet G, Chamorey E, et al. Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol. 2008;265:85–95.

    Article  PubMed  Google Scholar 

  10. Alan Turner MJ, Smith WP. Double venous anastomosis for the radial artery forearm flap. Improving success and minimising morbidity. J Craniomaxillofac Surg. 2009;37:253–7.

    PubMed  Google Scholar 

  11. Smith GI, O’Brien CJ, Choy ET, Andruchow JL, Gao K. Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of the oral cavity. Br J Oral Maxillofac Surg. 2005;43:199–204.

    Article  PubMed  CAS  Google Scholar 

  12. Ross GL, Ang ES, Lannon D, et al. Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis? Head Neck 2008;30:1086–9.

    Article  PubMed  Google Scholar 

  13. Thoma A, Archibald S, Jackson S, Young JE. Surgical patterns of venous drainage of the free forearm flap in head and neck reconstruction. Plast Reconstr Surg. 1994;93:54–9.

    Article  PubMed  CAS  Google Scholar 

  14. Netscher DT, Sharma S, Alford EL, Thornby J, Leibman NS. Superficial versus deep: options in venous drainage of the radial forearm free flap. Ann Plast Surg. 1996;36:536–41.

    Article  PubMed  CAS  Google Scholar 

  15. Medard de Chardon V, Balaguer T, Chignon-Sicard B, Riah Y, Ihrai T, Dannan E, Lebreton E. The radial forearm free flap: a review of microsurgical options. J Plast Reconstr Aesthet Surg. 2009;62:5–10.

    Article  PubMed  Google Scholar 

  16. Demirkan F, Wei FC, Lutz BS, Cher TS, Chen IH. Reliability of the venae comitantes in venous drainage of the free radial forearm flaps. Plast Reconstr Surg. 1998;102:1544–8.

    Article  PubMed  CAS  Google Scholar 

  17. Liu Y, Jiang X, Huang J, et al. Reliability of the superficial venous drainage of the radial forearm free flaps in oral and maxillofacial reconstruction. Microsurgery. 2008;28:243–7.

    Article  PubMed  CAS  Google Scholar 

  18. Gottlieb LJ, Tachmes L, Pielet RW. Improved venous drainage of the radial artery forearm free flap: use of the profundus cubitalis vein. J Reconstr Microsurg. 1993;9:281–4; discussion 284–5.

    Article  PubMed  CAS  Google Scholar 

  19. Valentino J, Funk GF, Hoffman HT, McCulloch TJ. The communicating vein and its use in the radial forearm free flap. Laryngoscope 1996;106:648–51.

    Article  PubMed  CAS  Google Scholar 

  20. Ichinose A, Tahara S, Yokoo S, et al. Fail-safe drainage procedure in free radial forearm flap transfer. J Reconstr Microsurg. 2003;19:371–6.

    Article  PubMed  Google Scholar 

  21. Ichinose A, Terashi H, Nakahara M, et al. Do multiple venous anastomoses reduce risk of thrombosis in free-flap transfer? Efficacy of dual anastomoses of separate venous systems. Ann Plast Surg. 2004;52:61–3.

    Article  PubMed  Google Scholar 

  22. Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL, Baldwin BJ. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg. 1996;98:1230–3.

    Article  PubMed  CAS  Google Scholar 

  23. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78:285–92.

    Article  PubMed  CAS  Google Scholar 

  24. Chalian AA, Anderson TD, Weinstein GS, Weber RS. Internal jugular vein versus external jugular vein anastomosis: implications for successful free tissue transfer. Head Neck. 2001;23:475–8.

    Article  PubMed  CAS  Google Scholar 

  25. Percival NJ, Sykes PJ, Earley MJ. Free flap surgery: the Welsh Regional Unit experience. Br J Plast Surg. 1989;42:435–40.

    Article  PubMed  CAS  Google Scholar 

  26. Francis DO, Stern RE, Zeitler D, Izzard M, Futran ND. Analysis of free flap viability based on recipient vein selection. Head Neck. 2009;31:1354–9.

    Article  PubMed  Google Scholar 

  27. Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg. 1999;103:403–11.

    Article  PubMed  CAS  Google Scholar 

  28. Cable DG, Mullany CJ, Schaff HV. The Allen test. Ann Thorac Surg. 1999;67:876–7.

    Article  PubMed  CAS  Google Scholar 

  29. Muhlbauer W, Herndl E, Stock W. The forearm flap. Plast Reconstr Surg. 1982;70:336–44.

    Article  PubMed  CAS  Google Scholar 

  30. Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, He SP. Forearm free skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg. 1997;50:162–5.

    Article  PubMed  CAS  Google Scholar 

  31. Hidalgo DA, Jones CS. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases. Plast Reconstr Surg. 1990;86:492–8; discussion 499–501.

    Article  PubMed  CAS  Google Scholar 

  32. Lineaweaver WC, Buncke HJ. Complications of free flap transfers. Hand Clin. 1986;2:347–51.

    PubMed  CAS  Google Scholar 

  33. Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg. 1986;78:1–8.

    Article  PubMed  CAS  Google Scholar 

  34. Ichinose A, Tahara S, Terashi H, Yokoo S, Nakahara M, Hashikawa K, Kenmoku K. Importance of the deep vein in the drainage of a radial forearm flap: a haemodynamic study. Scand J Plast Reconstr Surg Hand Surg. 2003;37:145–9.

    PubMed  Google Scholar 

  35. Evans GR, Schusterman MA, Kroll SS, Miller MJ, Reece GP, Robb GL, Ainslie N. The radial forearm free flap for head and neck reconstruction: a review. Am J Surg. 1994;168:446–50.

    Article  PubMed  CAS  Google Scholar 

  36. Futran ND, Stack BC Jr. Single versus dual venous drainage of the radial forearm free flap. Am J Otolaryngol. 1996;17:112–7.

    Article  PubMed  CAS  Google Scholar 

  37. Soutar DS, Scheker LR, Tanner NS, McGregor IA. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg. 1983;36:1–8.

    Article  PubMed  CAS  Google Scholar 

  38. Tahara S, Takagi T, Kinishi M, Makino K, Amatsu M. Role of the perforating vein in vascular pedicle of free forearm flap. Microsurgery. 1995;16:743–5.

    Article  PubMed  CAS  Google Scholar 

  39. Iseli TA, Yelverton JC, Iseli CE, Carroll WR, Magnuson JS, Rosenthal EL. Functional outcomes following secondary free flap reconstruction of the head and neck. Laryngoscope. 2009;119:856–60.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany

    Nils H. Rohleder MD, Klaus D. Wolff MD, Frank Hölzle MD, Rafael J. Hasler DDS & Marco R. Kesting MD

  2. Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany

    Stefan Wagenpfeil MSc

  3. Department of Oral and Maxillofacial Surgery, Southern General Hospital, Glasgow, UK

    Craig J. Wales FRCS

Authors
  1. Nils H. Rohleder MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus D. Wolff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank Hölzle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Wagenpfeil MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Craig J. Wales FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rafael J. Hasler DDS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco R. Kesting MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nils H. Rohleder MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rohleder, N.H., Wolff, K.D., Hölzle, F. et al. Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses. Ann Surg Oncol 18, 1980–1987 (2011). https://doi.org/10.1245/s10434-011-1555-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1555-0

Keywords

Search

Navigation