• Archives of Plastic Surgery
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• 제33권3호
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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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권4호
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• pp.248-255
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• 2013

Reconstruction techniques of orofacial defects caused by wide excision of the intraoral malignant lesions are various. Although radial forearm free flap is a common donor site on reconstruction of soft tissue defect, anterolateral thigh (ALT) free flap also has an established site in orofacial soft tissue reconstruction as the favored donor flap with recent progress of the microsurgical technique. A 59-year-old female complained of hyperplastic mass on the right retromolar and buccal cheek, which was diagnosed as a squamous cell carcinoma (SCC) by an incisional biopsy. Before the operation, we planned a wide excision of the SCC lesion, supraomohyoid neck dissection, reconstruction with radial forearm free flap (RFFF), and split thickness skin graft. We accidentally found an arterial variation of the forearm area during elevation of RFFF, and changed the plan of reconstruction operation to reconstruction with ALT free flap. Operative sites was healed well during the post-operative period, and we referred to the department of radiation oncology for post-operative radiotherapy.

• Archives of Plastic Surgery
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• 제33권4호
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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 Plastic Surgery
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• 제36권2호
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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 Reconstructive Microsurgery
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• 제11권2호
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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.

• 대한두개안면성형외과학회지
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• 제22권1호
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• pp.38-44
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• 2021

Background: The free flap surgical method is useful for the reconstruction of head and neck defects. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 30 years. Methods: Between 1989 and 2018, a total of 866 free flap procedures were performed on 859 patients with head and neck defects, including 7 double free flaps. The causes of vascular crisis and salvage rate were analyzed, and the total flap survival rate calculated among these patients. Additionally, the survival and complication rates for each flap type were compared. Results: The 866 cases included 557 radial forearm flaps, 200 anterolateral thigh flaps, 39 fibular osteocutaneous flaps, and 70 of various other flaps. The incidence of the vascular crisis was 5.1%; its most common cause was venous thrombosis (52.3%). Salvage surgery was successful in 52.3% of patients, and the total flap survival rate was 97.6%. The success rate of the radial forearm flap was higher than of the anterolateral flap (p< 0.01), and the primary sites of malignancy were the tongue, tonsils, and hypopharynx, respectively. Conclusion: The free flap technique is the most reliable method for head and neck reconstruction; however, the radial forearm free flap showed the highest success rate (98.9%). In patients with malignancy, flap failure was more common in the anterolateral thigh (5.5%) and fibular (5.1%) flaps.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.495-503
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• 2018

With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

• Archives of Reconstructive Microsurgery
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• 제12권2호
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• pp.119-124
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• 2003

Introduction : The purpose is a retrospective evaluation of the clinical results of the radial forearm flap transfer for foot reconstruction. Materials and methods : We evaluated 21 cases with medical records including etiology, wound dimension, presence of infection, associated fracture, ischemic time of free flap, complication of donor and recipient site. The final results were evaluated with our clinical score (walking, shoe-in, cosmetic). Results : Defects were located on the heel (12 cases), dorsum of foot (4 cases) and sole (5 cases). Mean wound dimension was $7.56{\times}6.0cm$, and mean ischemic time of free flap was 94.5minute. There were superficial skin necrosis (1 case), recurrent ulceration (2 cases) in recipient site, and no complication in donor site but complaint about cosmetic problem (3 cases). The clinical score showed excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 2 cases. Conclusion : We consider the radial forearm flap could provid the stable and durable restoration of normal foot contour without debulking in the foot reconstruction and achieved normal ambulation and cosmetic satisfaction.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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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.

• 대한두경부종양학회지
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• 제38권1호
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• pp.53-57
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• 2022

Reconstruction of subtotal maxillectomy defects with columella deficit is challenging. We report a unique case of facial reconstruction using a free radial forearm flap and a free preauricular flap for the maxillectomy and columella deficit. A 73-year-old woman was diagnosed with recurrent sebaceous carcinoma of the nose. We performed wide excision, including areas of the right cheek, nose, upper lip, maxilla, and columella. The resultant subtotal maxillectomy defect was reconstructed using a three-dimensional flap. First, a free radial forearm flap was transfered to resurface the nasal, oral, and external facial side. Second, a preauricular flap was positioned into the columella defect and anastomosed with the distal portion of the radial forearm flap pedicle. The two flaps survived, and the patient recovered uneventfully. We believe the radial forearm and preauricular double free flaps with the pedicle connection method were effective in reconstructing the present case of subtotal maxillectomy defect.