Application of radial forearm free flap in extraoral soft tissue head and neck reconstruction

Abstract

Background/Aim. Radial forearm free flap, highly regarded in head and neck reconstructive surgery, is known to be one of the most reliable and versatile flaps. The aim of this study was to illustrate the versatility and reliability of a radial forearm flap in reconstruction of a variety of extraoral head and neck defects. Methods. During a period 2001-2007 at the Clinic for Maxillofacial Surgery, Faculty of Dentistry and the Center for Burns, Plastic and Reconstructive Surgery in Belgrade, 19 patients underwent microsurgical reconstructions after extraoral tumor ablation in the head and neck region, using fasciocutaneous radial forearm free flap. Results. The overall flap survival rate was 89,5%. The complications that appeared were one partial necrosis and one venous thrombosis that in spite of reanastomosis resulted in a complete flap failure. The donor site healed uneventfully in all patients, except one, who had a partial skin graft failure, that ended in a secondary skin grafting. Conclusion. For reconstruction in head and neck surgery, with the need for thin, pliable tissues and a long vascular pedicle, radial forearm flap still remains a primary choice. Because of their multiple advantages, free flaps from the radial forearm is a safe method for reconstruction of a variety of extensive extraoral soft tissue defects in the head and neck region.Uvod/Cilj. Primena slobodnih mikrovaskularnih reznjeva u pokrivanju defekata glave i vrata postaje zlatni standard u rekonstruktivnoj hirurgiji. Slobodni radijalni rezanj je jedan od pogodnih reznjeva za pokrivanje defekata glave i vrata. Cilj rada bio je da se prikazu rezultati i mogucnosti primene slobodnih mikrovaskularnih radijalnih reznjeva u rekonstrukciji ekstraoralnih defekata koze i mekog tkiva glave i vrata. Metode. Tokom perioda od sest godina (2001-2007) u Klinici za maksilofacijalnu hirurgiju Stomatoloskog fakulteta u Beogradu i Centru za opekotine, plasticnu i rekonstruktivnu hirurgiju Klinickog centra Srbije, ekstraoralni mekotkivni defekti glave i vrata 19 bolesnika, nastali kao posledica radikalne ekscizije tumora, pokrivani su primenom slobodnog radijalnog reznja. Rezultati. U prikazanoj seriji bolesnika, postignut je potpuni uspeh u prezivljavanju reznja kod 89,5% bolesnika. Kod jednog bolesnika javila se parcijalna nekroza distalnog dela reznja, a kod drugog uspesno je izvedena revizija venske anastomoze, nastale usled tromboze u prva 24 sata. Davajuci region podlaktice uspesno je pokriven slobodnim koznim transplantatom, osim kod jednog bolesnika kod koga je doslo do nekroze transplantata. Zakljucak. Slobodni fasciokutani rezanj sa volarne strane podlaktice sigurno je resenje u pokrivanju ekstenzivnih mekotkivnih ekstraoralnih defekata glave i vrata.