• Archives of Plastic Surgery
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• v.36 no.2
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• pp.225-228
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• 2009

Purpose: Urethral reconstruction following failed hypospadias repair is difficult because of a severe shortage of the skin on ventral surface of the penis. We experienced a successful reconstruction of a failed hypospadias repair using the radial forearm free flap. So we present our case. Methods: A 16 - year - old boy had a proximal shaft hypospadias and had been taken a transverse preputial island flap but it completely broke down. There was no spare skin on the shaft of the penis. So we reconstructed a neo - urethra and the ventral skin of the penis with the radial forearm free flap. Results: Postoperatively he made relatively good process. The urethral catheter was maintained for 10 days and self - voiding was started. The suprapubic catheter was removed at the postoperative 30th day after control of cystitis. The postoperative appearance of the penis is acceptable and a straight erection is achieved. Conclusion: In the scarred penis with hypospadias, the radial forearm free flap transfer is a reliable reconstructive method for the neo - urethra and the ventral skin of the penis.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.407-412
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• 2006

Purpose: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. Methods: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3 centimeters. Results: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. Conclusion: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.

• Archives of Craniofacial Surgery
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• v.24 no.1
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• pp.28-31
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• 2023

The radial forearm free flap (RFFF) has become popular for head and neck reconstructions. Owing to a constant anatomy the RFFF is relatively easy to dissect. Nevertheless, anatomical variations of the radial artery have been reported. Some variations could affect the survival of the flap. This paper reports an unusual anomaly of the radial artery where the radial artery was not located between the brachioradialis (BR) and flexor carpi radialis. The radial artery was observed above the BR and on the radial side of the BR. The survival of the elevated flap was deemed questionable because it had only few perforators. So we decided to discard the flap and to elevate another free flap for the head and neck defect. The donor area on the forearm was covered using the original skin of the first flap as a full-thickness skin graft. This case highlights a means to deal with anomalies of the radial artery encountered during the elevation of RFFF and the checking process for variations of the radial artery before RFFF.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.205-207
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• 2008

Purpose: Although muscle hernia has been well described in the lower-extremity, muscle hernias in the upper extremity are extremely rare. As with lower extremity muscle hernias, the forearm muscle hernia may result from forced exertion of strenuous activity or following blunt trauma. The objective of this paper is to report an extraordinary case of forearm muscle hernia after radial forearm sensory tendocutaneous free flap with references. Methods: A 58-year-old male patient received wide excision and radical neck dissection and lower lip reconstruction with radial forearm sensory tendocutaneous free flap for squamous cell cancer on the lower lip. 16 weeks after the operation, he complained of protruding mass on the forearm and the size was increasing. In postoperative 18 weeks, MRI showed herniation of flexor digitorum superficialis. For unaesthetic cause and preventing progress, the authors performed direct fascial closure and Mesh graft. Results: In 12 months after the surgery there was no recurrence and the patient remained symptom-free. Conclusion: Pain on extremity exertion and unaesthetic buldge of forearm due to forearm muscle hernia were the primary indications for surgery which consist of direct closure, fasciotomy, fascia lata onlay graft, fascia lata inlay graft, etc. The authors experienced uncommon forearm muscle hernia after radial forearm free flap and satisfying result of treatment.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.48-52
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• 2011

Purpose: Many advances have been made in lower eyelid reconstruction surgical procedures after tumor ablative therapy. These include skin grafts, local flaps, free flaps, and skin expansion. When a full-thickness defect of the lower eyelid is reconstructed with many free flaps, ectropion and deformity of the medial and lateral canthal areas are common late complications caused by gravitational descent. The radial forearm free flap is widely used because of its lack of bulk, ease of dissection, malleability, and hairlessness. This report introduces a novel method for preventing ectropion using a composite radial forearm free flap reconstruction and palmaris longus suspension technique. Methods: A 70-year-old man had a malignant melanoma on his left lower eyelid. The patient was referred to our department after a biopsy confirmed the initial diagnosis. A full-thickness wide resection with a 25 mm free margin was performed, and a $5{\times}8cm$ radial forearm flap was elevated with a vascularised palmaris longus tendon. The palmaris longus tendon was fixed to the medial and lateral orbital rim perisoteum and the deep temporal fascia. The buccal mucosa was grafted to reconstruct the inner conjunctival layer. The pedicle vessels were anastomosed to the left superficial temporal artery and vein. Results: The postoperative clinical course was uneventful. The flap showed good texture and color match. No ectropion was noted 14 months after surgery and the tumor did not recur. The patient was quite satisfied with the final outcomes. Conclusion: Use of a radial forearm free flap and the palmaris longus tendon is an effective method for a full-thickness lower eyelid reconstruction.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.31-36
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• 2005

Purpose: We analyzed the result of the radial forearm island flap for the reconstruction of amputated fingers. Materials and Methods: From March 2001 to February 2004, we assessed two patients who could not be able to receive replantation and six patients who had necrosis of the fingers after replantation. There were six men and two women. The mean age was 42 years. The average duration of follow-up was 26months. Results: All flaps were survived. Two patients needed bone graft. Two patients needed curettage due to osteomyelitis. All patients needed fat reduction procedure. No patients needed amputation of reconstructed digit due to complication. Conclusion: Radial forearm island flap seems useful operation procedure for severely amputated digit or necrotized digit after replantation.

• The Journal of the Korean dental association
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• v.48 no.8
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• pp.607-614
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• 2010

Reconstruction after ablative oral cancer surgery is challenging mission. Soft tissue and hard tissue could be resected in case of advanced oral cancer. The final goal of oral reconstruction is to gain normal swallowing, chewing and speech. Nowadays, free flap reconstruction after oral cancer resection is more popular than pedicled flap. Microsurgical reconstruction with free flap could be used effectively in complicated cases of oral cavity defect. However, complications could be happened. So not only meticulous preoperative study about the extent of defects but also the donor site dressing after surgery were performed to prevent postoperative complication. The most favorite free flap for soft tissue reconstruction is radial forearm flap. It has a lot of advantages such as pliable, hairless, reliable vessels, appropriate diameter of radial artery and diverse flap design. And the most popular free flap for jaw reconstruction is free fibular flap. In this article, we report the classification of flap for reconstruction and reveal the pits and falls of radial forearm free flap and free fibular flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.4
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• pp.353-358
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• 2008

Purpose: The purpose of this clinical retrospective study was to evaluate our experience of radial forearm free flap for reconstruction of the oral cavity. Material and methods: From 1997 to 2006, 50 radial forearm free flaps were employed for head and neck reconstruction in 50 patients at department of oral and maxillofacial surgery, Yonsei University, Korea. Data were obtained from chart review, and clinical follow-up. Results: Patients' age ranged from 26 to 82 years (mean 53.2). There were 39 men and 11 women. 43 of the 50(86%) patients had squamous cell carcinoma. The total flap survival were 47(94%), complication rate were revealed for 15(30%). Conclusion: In the reconstruction of soft tissue within the oral cavity, several free flaps have been used. Because of its constant anatomy, long pedicle allows a hypothetic vascular anastomosis in the contralateral neck, contourability for various type of oral defects, pliability and can be used simultaneous reconstruction in intraoral and extra oral defects, the radial forearm free flap constitutes one of the best choice of intraoral soft tissue reconstruction.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.146-152
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• 2002

As the defects of the penis caused by trauma, surgical amputation, or congenital abnormality give the patients both psychological trauma and functional impairment, reconstruction of the penis is mandatory. Radial forearm free flap is reliable one-stage procedure, which can reconstruct both the phallus and the urethra. Chang and Whang's adaptation of the "tube-in-a-tube" concept and its incorporation into a free flap design represented a major advance in microsurgical phallic construction. Biemer described a modification of the radial forearm flap design in which the neourethra was centered over the radial artery, but the phallic shaft was separated into two paraurethral swatches. The authors have performed one-stage penile reconstruction in two patients since 1998, using a radial forearm free flap. Our present design incorporates the original Biemer triple skin island and includes a fourth distal island for neoglans. One case was the amputation of the penis from felonious assault and the other case was the iatrogenic penile amputation from repetitive urologic surgery for congenital hypospadia. All patients showed aesthetically acceptable results and good tactile sensory recovery. Severe complications such as necrosis, fistula, or urethral stricture were not occurred. Biemer's method modified by the authors is reliable one-stage penile reconstruction providing good aesthetic and functional results.

• Archives of Plastic Surgery
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• v.33 no.3
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• pp.283-288
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• 2006

Various vascularized free flaps have been used for midfacial reconstruction after ablative head and neck cancer surgery. The most common donor sites for free flap include latissimus dorsi, rectus abdominis, and radial forearm. Between 1994 and 2004, 14 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among 14 free flaps, 8 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps and 3 radial forearm flaps, respectively. The overall survival rate of the flap was 100%. Complications were wound dehiscence(5 cases) and ptosis(1 case). We designed multiple dimensionally folded free flap for midfacial reconstruction. For 3-dimensional flap needs, we used latissimus dorsi myocutaneous flap. 2-Dimensional flap was latissimus dorsi or rectus abdominis myocutaneous flap and 1-dimensional flap was radial forearm flap. In this study we produced an algorithm for midfacial reconstruction. Large volume with many skin paddle defects were best reconstructed with latissimus dorsi myocutaneous flap or rectus abdominis myocutaneous flap. Radial forearm flap was used for reconstruction of small volume and little skin paddle defects.