Abstract
The aim of this study was to report the patient characteristics and radial fracture
rates in a consecutive series of composite radial forearm free flap (CRFFF) for head
and neck reconstruction over a 31-year period. The patients were identified from between
1990 to 2020 inclusive from theatre records and records from previous analyses at
the Unit on free flap outcomes. Electronic case notes were accessed where available,
to gather information on the operation, histopathology, and radiographs. Patients
were categorized into three groups for analysis: (1) new oral cancers with a composite
radial being the first choice of flap, (2) new oral cancers with a composite radial
being the choice of flap following compromise of another bony flap, (3) osteoradionecrosis
(ORN) cases. There were 103 CRFFF cases, median (IQR) age 69 (59-80) years, comprising
78 (Group 1), 5 (Group 2) and 20 (Group 3). The CRFFF failure rate was 6% (6/103)
and the radius fracture rate was also 6% (6/103), both with 95% confidence interval
2.2-12.2%. Of the 6 radius fractures, 1 underwent surgical management (rush nailing),
1 died in hospital and the others managed with cast immobilisation. Two-year overall
survival after surgery for the103 patients was 54% (SE 5%), while 5-year survival
was 40% (SE 5%). In conclusion, in spite of the familiarity with other bone flaps
such as fibula free flap, DCIA, scapula, and the limited bone stock and potential
fracture related morbidity associated with the CRFFF, this flap still has a place
in the surgical reconstructive armamentarium.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to British Journal of Oral and Maxillofacial SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years.Br J Oral Maxillofac Surg. 2017 Feb; 55: 113-126
- The indications and outcomes in the use of osteocutaneous radial forearm free flap.Head Neck. 2003 Jun; 25: 475-478
- Reconstruction of midface defects with the osteocutaneous radial forearm flap: Evaluation of long term outcomes including patient reported quality of life.Microsurgery. 2017 Oct; 37: 752-762
- Radial forearm flap donor site complications and morbidity: a prospective study.Plast Reconstr Surg. 1997; 9991): 109-115
Clark S, Greenwood M, Banks RJ, Parker R. Fracture of the radial donor site after composite free flap harvest: a ten-year review Surgeon. 2004 Oct;2(5):281-6.
- Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function.Int. J. Oral Maxillofac. Surg. 2001; 30: 42-48
- The radial forearm flap: a biomechanical study of the osteotomized radius.Plast Reconstr Surg. 1990; 85: 267-272
- Reducing morbidity in the radial forearm flap donor site.Plast Reconstr Surg. 1990; 86: 287-294
- Outcomes of the osteocutaneous radial forearm free flap for mandibular reconstruction.JAMA Otolaryngol Head Neck Surg. 2013 Feb; 139: 168-172
- Oromandibular reconstruction using a keel-shaped modification of the radial forearm osteocutaneous flap.Ann Plast Surg. 1994; 33: 359-370
- Radial forearm osteocutaneous free flap in maxillofacial and oromandibular reconstructions.Laryngoscope. 2005 Sep; 115: 1697-1701
- Outcomes of microvascular composite reconstruction for mandibular osteoradionecrosis.Br J Oral Maxillofac Surg. 2020 Dec 2; S0266–4356: 30903-30907
- A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.Plast Reconstr Surg. 2000 Jun; 105: 2331-2346
- Developments in reconstruction of midface and maxilla.Lancet Oncol. 2006 Mar; 7: 249-258
- Expanding the Utilization of the Osteocutaneous Radial Forearm Free Flap beyond Mandibular Reconstruction.J Reconstr Microsurg. 2016 Jun; 32: 361-365
- The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy.Int J Implant Dent. 2017 Dec; 3: 37
- Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction.Head Neck. 2017 Sep; 39: 1888-1893
- Radial forearm free tissue transfer for head and neck reconstruction: versatility and reliability of a single donor site.Microsurgery. 2000; 20: 195-201
- Outcomes after free tissue transfer for composite oral cavity resections involving skin.Head Neck. 2018 May; 40: 973-984
Lydiatt WM, Patel SG, O'Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Loomis AM, Shah JP. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Mar;67(2):122–137.
- Trends in head and neck microvascular reconstructive surgery in Liverpool (1992–2001).Br J Oral Maxillofac Surg. 2006 Oct; 44: 364-370
- Salvage outcomes of free tissue transfer in Liverpool: trends over 18 years (1992–2009).Br J Oral Maxillofac Surg. 2012 Jan; 50: 13-18
- 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 Mar; 38: 434-438
- Safe osteocutaneous radial forearm flap harvest with prophylactic internal fixation.Craniomaxillofac Trauma Reconstr. 2011 Sep; 4: 129-136
- Assessment of donor site morbidity for free radial forearm osteocutaneous flaps.Microsurgery. 2012 May; 32: 255-260
- Osteocutaneous radial forearm free flap: its use without significant donor site morbidity.Otolaryngol Head Neck Surg. 2000 Dec; 123: 711-717
- Prophylactic plating of the donor site of osteocutaneous radial forearm flaps.Br J Oral Maxillofac Surg. 1999 Jun; 37: 210-212
- Donor site morbidity of composite free flaps in head and neck surgery: a systematic review of the prospective literature.Int J Oral Maxillofac Surg. 2021 Sep; 50: 1147-1155
- Analysis of outcomes of vascularized flap reconstruction in patients with advanced mandibular osteoradionecrosis.Otolaryngol Head Neck Surg. 2009 Aug; 141: 196-201
Article Info
Publication History
Published online: February 17, 2022
Accepted:
January 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
