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 categorised 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 fibular 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
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Article Info
Publication History
Published online: February 17, 2022
Accepted:
January 26,
2022
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
