• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.1
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• pp.93-101
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• 2011

Reconstruction following a resection of malignant oral cavity tumors is one of the most difficult problems in recent oral oncology. The radial forearm free flap (RFFF) is a thin, pliable soft tissue flap with large-caliber vessels for microvascular anastomosis. Its additional advantages include consistent flap vascular anatomy, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with a tumor resection. For a better understanding of RFFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings must be learned and memorized by young doctors during the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article discusses the anatomical basis of RFFF in the Korean language.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.14.1-14.4
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• 2017

Tissue defect reconstruction using radial forearm free flap (RFFF) is a common surgical technique whose success or failure is mainly dependent on venous drainage. RFFF has two major venous outflow systems, superficial and deep vein. Drainage methods include combining both systems or using one alone. This review aims to recapitulate the vascular anatomy and network of RFFF as well as shed light on deep vein as a reliable venous drainage system. We also discuss basic evidence for and advantages of single microanastomosis with coalesced vein to overcome technical difficulties associated with the deep vein system.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.8-13
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• 2011

Purpose: A palatal defect following maxillectomy can cause multiple problems like the rhinolalia, leakage of foods into the nasal cavity, and hypernasality. Use of a prosthetic is the preferred method for obturating a palate defect, but for rehabilitating palatal function, prosthetics have many shortcomings. In a small defect, local flap is a useful method, however, the size of flap which can be elevated is limited. In 12 cases of palatomaxillary defect, we used various microvascular free flaps in reconstructing the palate and obtained good functional results. Method: Between 1990 and 2004, 12 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among the 12 free flaps, 6 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps, and 3 radial forearm flaps. Result: All microvascular flap surgery was successful. Mean follow up time was 8 months and after the follow up time all patients reported satisfactory speech and swallowing. Wound dehiscence was observed in 4 cases, ptosis was in 1 case and fistula was in 1 case, however, rhinolalia, leakage of food, or swallowing difficultly was not reported in the 12 cases. Conclusion: We used various microvascular flaps for palatomaxillary reconstruction. For 3-dimensional flap needs, we used the latissimus dorsi myocutaneous flap to obtain enough volume for filling the defect. Two-dimensional flaps were designed with latissimus dorsi myocutaneous flap, rectus abdominis flap and radial forearm flap. For cases with palatal defect only, we used the radial forearm flap. In palatomaxillary reconstruction, we can choose various free flap techniques according to the number of skin paddles and flap volume needed.

• Korean Journal of Bronchoesophagology
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• v.5 no.2
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• pp.191-197
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• 1999

Background and Objective : Soft palate plays a great role in function of speech and swallowing. Ablation of tonsil cancer results in multi-demensional defect including soft palate in most cases and restoration of the postoperative oral cavity function is a continuing surgical challenge. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for these defect, which offers a thin, pliable, and relatively hairless skin, and a long vascular pedicle. The aim of the present study is to report the speech and swallowing function test results of our 5 consecutive radial forearm free flaps used for tonsil cancers. Materials and Methods : We reviewed the medical records of 5 patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for tonsil cancers, from Dec. 1997 to Oct. 1998, and analyzed the surgical methods, complications, and speech and swallowing function test results. We have examined with modified barium swallow to evaluate postoperative wallowing function and articulation and resonance test for speech. Results : The tumor sizes by TNM stage(AJCC, 1997) were T1(1), T2(2), and T4(3). The paddles of flaps were tailored in multilobed designs from oval shape to pentalobed design and in variable size from 24$cm^2$ to 108$cm^2$(average size = 78.4$cm^2$), according to the defect after ablation. This procedures resulted in satisfactory flap success and functional results all but 1 case of flap contracture in 2 postoperative week, achieved early oral diet until 16-57 postoperative day(average, 28 days) and social speech. The oropharyngeal defect including soft palate reconstruction with radial forearm free flap might be an excellent method for the maximal functional results, after ablative surgery of tonsil cancer that results in multidimensional defect.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.216-220
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• 2001

There are many approaches in surgery of posterior hypopharyngeal wall cancer according to location, extent, and invasion depth of primary cancer. And many reconstruction methods have been used in reconstruction of surgical defect remaining after wide resection of primary cancer. Posterior hypopharyngeal wall cancer is relatively rare, so its surgical experiences are fewer than those of pyriform sinus cancer and there have been few reports of surgical approaches and reconstruction methods of posterior hypopharyngeal wall cancer. Recently, we experienced a case of posterior hypopharyngeal wall cancer reconstructed with longus colli flap and skin graft after failure of radial forearm free flap in a 72-year -old man and report it with the review of the literatures.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.172-178
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• 2000

With esthetic concern in the reconstruction of skin and soft tissue defects of face, the use of local flap has been the method of choice. However, when there is extensive tissue loss in the face, local flaps do not provide satisfactory results. The amazing development of microsurgical technique has decreased the percentage of free flap failure, thus making free flap use in reconstruction of facial soft tissue defects. Many free flaps has been applied for reconstruction of face defects. Especially, the radial forearm flap has numerous advantages with which facial reconstruction is made possible. But, its disadvantages are ; the sacrifice of one major artery supplying the hand and donor site complications. In order to circumvent these disadvantages, we employed posterior interosseous artery(PIA) forearm free flap for the reconstruction of the face defects. The posterior interosseous forearm island flap was first described by Zancolli and Angrigiani(1985). Currently, the PIA island flap and free flap have been used for hand reconstructions. The disadvantages of the PIA flap are ; the small caliber of the pedicle, different locations of the perforating branches, and the proximity of the motor branch of the radial nerve. But, its advantages lies in preserving the major artery of the hand, minimal donor site morbidity, and fairly well matched skin texture and color, and that the flap volume is sufficient, not too bulky with convenient handling. By using this flap, we performed 1 case of tumor resection and 1 case of traumatic defect. From our experiences we conclude that it is one of many useful methods in the reconstruction of the skin and soft tissue defects of the face. We also have discussed advantages and some limitations of various free flaps for reconstruction of the face.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.41-46
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• 2003

Background and Objectives: Surgical ablation of tumors in the oral cavity and the oropharynx results in a three dimensional defect because of the needs to resect the adjacent area for the surgical margin. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for this defect, which offers a thin, pliable, and relatively hairless skin and a long vascular pedicle. We report the clinical results of our 54 consecutive radial forearm free flaps used for oral cavity and oropharynx cancers. Materials and Methods: We reviewed the medical records of patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for oral cavity and oropharyngeal cancers from August 1994 to February 2003 and analyzed surgical methods, flap survival rate, complication, and functional results. Among these, 20 cases were examined with modified barium swallow to evaluate postoperative swallowing function and other 8 cases with articulation and resonance test for speech. We examined recovery of sensation with two-point discrimination test in 15 cases who were offered sensate flaps. Results: The primary sites were as follows : mobile tongue (18), tonsil (17), floor of mouth (4), base of tongue (2), soft palate (2), retromolar trigone (3), buccal mucosa (1), oro-hypopharynx (6), and lower lip (1). The paddles of flaps were tailored in multilobed designs from oval shape to tetralobed design and in variable size according to the defects after ablation. This procedures resulted in satisfactory flap success rate (96.3%) and showed good swallowing function and social speech. Eight of 15 cases (53.3%) who had offered sensate flap showed recovery of sensation between 1 and 6 postoperative months (average 2.6 month). Conclusion: The reconstruction with radial forearm free flap might be an excellent method for the maximal functional results after ablative surgery of oral cavity and oropharyngeal cancers that results in multidimensional defect.

• The Journal of the Korean dental association
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• v.52 no.10
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• pp.615-622
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• 2014

Oral cancer ablation surgery results in tissue defects with functional loss. Accompanying neck dissection results in facial nerve weakness and dysmorphic changes. To minimize the complications after oral cancer surgery, accurate dissection without damaging facial nerve and vital structures are mandatory. Marginal mandibular branch of facial nerve should be dissected or contained in the superficial layer of deep cervical fascia to minimized facial palsy after operation. Reconstruction after cancer ablations is routine procedures and free flap reconstruction is the most commonly used. Radial forearm free flap is the most versatile flap to reconstruct soft tissue defects and it is easy to design according to the defect size and shape. However, donor site scar and secondary skin graft from thigh result in unesthetic and cumbersome wounds. Double layered collagen graft in the donor site could reduce secondary donor site for skin graft. In conclusion, oral and maxillofacial surgeon should know the exact anatomy of the face and neck during neck dissection. Radial forearm free flap is most versatile flap for soft tissue reconstruction and double collagen graft can reduce postoperative scar and there is no need for secondary skin graft.

• Korean Journal of Head & Neck Oncology
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• v.19 no.2
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• pp.164-169
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• 2003

Background and Objectives: The reconstruction is very important in Head and neck cancer surgery to repair the defect created by resection of tumors, to enable successful wound healing, to restore function and to provide acceptable cosmesis. The radial forearm free flap has been the most useful reconstructive flap because it provides a moderate amount of thin, pliable, relatively hairless skin and comparatively simple to do with minimal morbidity. The aims of this study is to estimate the outcome of the reconstruction with radial forearm free flap with the several factors in 140 head and neck cancer cases in our hospital for last 10 years. Materials and Methods: Retrospective review of the records of 140 patients underwent resection of the head and neck tumors and reconstruction with a radial forearm free flap from 1993 to 2003. The age, sex of the patients, Primary site, the complication of donor and recipient site, flap survival rate, median time to start diet, patient subjective symtoms about swallowing and articulating and the fact of revision reconstructive surgery were analyzed. Results: In primary pathologic site, 56 cases were oral cavity cancers, 44 cases, oropharyngeal cancers and 22 cases, hypopharyngeal cancers. Flap survival rate was 93.6% (13 leases). On donor site, wound dehiscence, hematoma, sensory change and infection were noted and on recipient site, most common complication were fistula and wound dehiscence. The complication rate of recipient's site was 19.1 % and donor site, 3.5%. In 118 cases (84.3%), the patients could take all kinds of food. Swallowing difficulty were noted in 22 cases 05.7%). In 5 cases, there was articulation difficulty but most of patients except patients having total laryngectomy (18 cases) couldn't have any difficulty in articulation and speaking. Conclusion: We conclude that the radial forearm free flap is the most appropriate reconstructive material for treating the defect in head and neck reconstruction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.45.1-45.8
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• 2015

Background: Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft. Methods: Twenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27-84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated. Results: An average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer. Conclusions: Double-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.