Reconstruction of various intraoral and extraoral
defects with radial forearm free flap
Lampros P. GOUTZANIS, Marco R. KESTING, Denys J. LOEFFELBEIN, Florian BAUER, Klaus-Dietrich WOLFF
Department of Oral and Maxillofacial Surgery, (Head: Univ.-Prof. Dr. Dr. K.-D. Wolff), Klinikum rechts der Isar, Technische
Universität München, Munich, Germany
Hellenic Archives of Oral & Maxillofacial Surgery (2015) 3, 119-128
SUMMARY: Introduction. The radial forearm free flap (RFFF) is the most commonly used vascularized free flap
to repair extensive defects arising after resection of tumors of the oral and maxillofacial region.
Purpose. The purpose of this paper is to present the applications of radial forearm free flap.
Patients and methods. The records of 45 patients who were treated with RFFF, from1/7/2013 until 31/12/2013,
were systematically reviewed and analyzed. Results. In six months, 45 RFFF were used to reconstruct
defects of various sites of the head and neck. Only one flap was completely necrotic, which means that a success
rate of 97.8% (44 of 45) was observed. Conclusions: The radial forearm free flap is a unique tool,
because it allows reconstruction of most of the defects in the head and neck area.
KEY WORDS: Radial forearm free flap; Oral Cancer; Reconstruction;
Microsurgery; Head and Neck.
REFERENCES
Brown JS, Magennis P, Rogers SN, et al: Trends in head and neck microvascular
reconstructive surgery in Liverpool (1992-2001). Br J
Oral Maxillofac Surg 44:364-370, 2006
Demirkan F, Wei FC, Lutz BS, Cher TS, Chen IH: Reliability of the
venae comitantes in venous drainage of the free radial forearm
flaps. Plast Reconstr Surg 102:1544-8, 1998
Eckardt A, Fokas K: Microsurgical reconstruction in the headand neck
region: an 18-year experience with 500 consecutivecases. J Craniomaxillofac
Surg 31:197-201, 2003
Cable DG, Mullany CJ, SchaffHV: The Allen test. Ann Thorac Surg
67:876-7, 1999
Chalian AA, Anderson TD, Weinstein GS, Weber RS: Internal jugular
vein versus external jugular vein anastomosis: implications for successful
free tissue transfer. Head Neck 23: 475-8, 2001
Cheng BS: Free forearm flap transplantation in repair and reconstruction
of tongue defects. Zhonghua Kou QiangKeZaZhi 18(1):39-
41, 1983
Chen HC, Ganos DL, Coessens BC, Kyutoku S, Noordhoff MS: Free
forearm flap for closure of difficult oronasal fistulas in cleft palate
patients. Plast Reconstr Surg 90(5):757-62, 1992
Futran ND, Gal TJ, Farwell DG: Radial forearm free flap. Oral Maxillofac
Surg Clin North Am 15:577-91, vi-vii, 2003
Godina M: Early microsurgical reconstruction of complex trauma of
the extremities. Plast Reconstr Surg 78:285-92, 1986
González-García R, Rodríguez-Campo FJ, Naval-Gías L, Sastre-Pérez J,
Muñoz-Guerra MF, UsandizagaJL, Díaz-González FJ: Radial forearm
free flap for reconstruction of the oral cavity: clinical experience
in 55 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
Jul; 104(1):29-37, 2007
Hatoko M, Harashina T, Inoue T, Tanaka I, Imai K: Reconstruction of
palate with radial forearm flap; a report of 3 cases. Br J Plast Surg.
43(3):350-4, 1990
Jacobson MC, Franssen E, Fliss DM, Birt BD, Gilbert RW. Free forearm
flap in oral reconstruction. Functional outcome. Arch Otolaryngol
Head Neck Surg 121:959-64, 1995
Kesting MR, Hölzle F, Wales C, Steinstraesser L, Wagenpfeil S, Mücke
T, Rohleder NH, Wolff KD, Hasler RJ: Microsurgical reconstruction
of the oral cavity with free flaps from the anterolateral thigh
and the radial forearm: a comparison of perioperative data from
161 cases. Ann Surg Oncol 18(7):1988-94, 2011
Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL,
Baldwin BJ: Timing of pedicle thrombosis and flap loss after freetissue
transfer. Plast Reconstr Surg 98: 1230-3, 1996
Kruse AL, Bredell MG, Lübbers HT, Jacobsen C, Grätz KW, Obwegeser
JA: Clinical reliability of radial forearm free-flap procedure
in reconstructive head and neck surgery. J Craniofac Surg
22(3):822-5, 2011
Loeffelbein DJ, Al-Benna S, Steinsträßer L, Satanovskij RM, Rohleder
NH, Mücke T, Wolff KD, Kesting MR: Reduction of donor site
morbidity of free radial forearm flaps: what level of evidence is
available? Eplasty.12:e9, 2012
Liu Y, Jiang X, Huang J, et al. Reliability of the superficial venous
drainage of the radial forearm free flaps in oral and maxillofacial
reconstruction. Microsurgery 28:243-7, 2008
Medard de Chardon V, Balaguer T, Chignon-Sicard B, Riah Y, Ihrai T,
Dannan E, Lebreton E: The radial forearm free flap: a review of
microsurgical options. J Plast Reconstr Aesthet Surg 62:5-10, 2009
Mühlbauer W, Herndl E, Stock W: The forearm flap. PlastReconstr
Surg 70(3):336-44, 1982
Netscher DT, Sharma S, Alford EL, Thornby J, Leibman NS: Superficial
versus deep: options in venous drainage of the radial forearm free
flap. Ann Plast Surg 36:536-41, 1996
Niranjan NS, Watson DP: Reconstruction of the cheek using a "suspended"
radial forearm free flap. Br J Plast Surg 43(3):365-6, 1990
O’Brien CJ, Lee KK, Castle GK, Hughes CJ: Comprehensive treatment
strategy for oral and oropharyngeal cancer. AmJ Surg. 164:582-6,
1992
Percival NJ, Sykes PJ, Earley MJ: Free flap surgery: the Welsh Regional
Unit experience. Br J Plast Surg. 42:435-40, 1989
Rohleder NH, Wolff KD, Hölzle F, Wagenpfeil S, Wales CJ, Hasler RJ,
Kesting MR: Secondary maxillofacial reconstruction with the radial
forearm free flap: a standard operating procedure for the venous
microanastomoses. Ann Surg Oncol 18(7):1980-7, 2011
Schusterman MA, Miller MJ, Reece GP, et al: A single centre experience
with 308 free flap repairs of head and neck defects. Plast Reconstr
Surg 93:472-8, 1994
Smith GI, O’Brien CJ, Choy ET, et al: Clinical outcome and technical
aspects of 263 radial forearm free flaps used in reconstruction of
the oral cavity. Br J Oral Maxillofac Surg. 43:199-204, 2005
Song R, Gao Y, Song Y, Yu Y, Song Y.: The forearm flap. ClinPlast Surg
9(1):21-6, 1982
Soutar DS, Scheker LR, Tanner NSB, McGregor IA: The radial forearm
flap. A versatile method for intra-oral reconstruction. Br J Plast
Surg. 36:1-8, 1983
Soutar DS, McGregor IA: The radial forearm flap in intraoral reconstruction:
the experience of 60 consecutive cases. Plast Reconstr
Surg. 78:1-8, 1986
Thoma A, Archibald S, Jackson S, Young JE: Surgical patterns of venous
drainage of the free forearm flap in head and neck reconstruction.
Plast Reconstr Surg. 93:54-9, 1994
Vaughan ED. The radial forearm free flap in orofacial reconstruction:
personal experience in 120 consecutive cases. J Craniomaxillofac
Surg 18:2-7, 1990
Vaughan ED: The radial forearm in orofacial reconstruction. Int J Oral
Maxillofac Surg 23:194-204, 1994
Wong CH, Wei FC: Microsurgical free flap in head and neck reconstruction.
Head Neck 32:1236-45, 2010
Wolff K-D, Hölzle F: Raising of Microvascular flaps. A systematic approach.
2nd Ed, Springer 2011, pp 1-20
Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, He SP: Forearm free
skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg
1997 50(3):162-5, 1997
Francis DO, Stern RE, Zeitler D, Izzard M, Futran ND. Analysis of free
flap viability based on recipient vein selection. Head Neck
31:1354–9, 2009
Department of Oral and Maxillofacial Surgery, (Head: Univ.-Prof. Dr. Dr. K.-D. Wolff), Klinikum rechts der Isar, Technische
Universität München, Munich, Germany
Hellenic Archives of Oral & Maxillofacial Surgery (2015) 3, 119-128
SUMMARY: Introduction. The radial forearm free flap (RFFF) is the most commonly used vascularized free flap
to repair extensive defects arising after resection of tumors of the oral and maxillofacial region.
Purpose. The purpose of this paper is to present the applications of radial forearm free flap.
Patients and methods. The records of 45 patients who were treated with RFFF, from1/7/2013 until 31/12/2013,
were systematically reviewed and analyzed. Results. In six months, 45 RFFF were used to reconstruct
defects of various sites of the head and neck. Only one flap was completely necrotic, which means that a success
rate of 97.8% (44 of 45) was observed. Conclusions: The radial forearm free flap is a unique tool,
because it allows reconstruction of most of the defects in the head and neck area.
KEY WORDS: Radial forearm free flap; Oral Cancer; Reconstruction;
Microsurgery; Head and Neck.
REFERENCES
Brown JS, Magennis P, Rogers SN, et al: Trends in head and neck microvascular
reconstructive surgery in Liverpool (1992-2001). Br J
Oral Maxillofac Surg 44:364-370, 2006
Demirkan F, Wei FC, Lutz BS, Cher TS, Chen IH: Reliability of the
venae comitantes in venous drainage of the free radial forearm
flaps. Plast Reconstr Surg 102:1544-8, 1998
Eckardt A, Fokas K: Microsurgical reconstruction in the headand neck
region: an 18-year experience with 500 consecutivecases. J Craniomaxillofac
Surg 31:197-201, 2003
Cable DG, Mullany CJ, SchaffHV: The Allen test. Ann Thorac Surg
67:876-7, 1999
Chalian AA, Anderson TD, Weinstein GS, Weber RS: Internal jugular
vein versus external jugular vein anastomosis: implications for successful
free tissue transfer. Head Neck 23: 475-8, 2001
Cheng BS: Free forearm flap transplantation in repair and reconstruction
of tongue defects. Zhonghua Kou QiangKeZaZhi 18(1):39-
41, 1983
Chen HC, Ganos DL, Coessens BC, Kyutoku S, Noordhoff MS: Free
forearm flap for closure of difficult oronasal fistulas in cleft palate
patients. Plast Reconstr Surg 90(5):757-62, 1992
Futran ND, Gal TJ, Farwell DG: Radial forearm free flap. Oral Maxillofac
Surg Clin North Am 15:577-91, vi-vii, 2003
Godina M: Early microsurgical reconstruction of complex trauma of
the extremities. Plast Reconstr Surg 78:285-92, 1986
González-García R, Rodríguez-Campo FJ, Naval-Gías L, Sastre-Pérez J,
Muñoz-Guerra MF, UsandizagaJL, Díaz-González FJ: Radial forearm
free flap for reconstruction of the oral cavity: clinical experience
in 55 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
Jul; 104(1):29-37, 2007
Hatoko M, Harashina T, Inoue T, Tanaka I, Imai K: Reconstruction of
palate with radial forearm flap; a report of 3 cases. Br J Plast Surg.
43(3):350-4, 1990
Jacobson MC, Franssen E, Fliss DM, Birt BD, Gilbert RW. Free forearm
flap in oral reconstruction. Functional outcome. Arch Otolaryngol
Head Neck Surg 121:959-64, 1995
Kesting MR, Hölzle F, Wales C, Steinstraesser L, Wagenpfeil S, Mücke
T, Rohleder NH, Wolff KD, Hasler RJ: Microsurgical reconstruction
of the oral cavity with free flaps from the anterolateral thigh
and the radial forearm: a comparison of perioperative data from
161 cases. Ann Surg Oncol 18(7):1988-94, 2011
Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL,
Baldwin BJ: Timing of pedicle thrombosis and flap loss after freetissue
transfer. Plast Reconstr Surg 98: 1230-3, 1996
Kruse AL, Bredell MG, Lübbers HT, Jacobsen C, Grätz KW, Obwegeser
JA: Clinical reliability of radial forearm free-flap procedure
in reconstructive head and neck surgery. J Craniofac Surg
22(3):822-5, 2011
Loeffelbein DJ, Al-Benna S, Steinsträßer L, Satanovskij RM, Rohleder
NH, Mücke T, Wolff KD, Kesting MR: Reduction of donor site
morbidity of free radial forearm flaps: what level of evidence is
available? Eplasty.12:e9, 2012
Liu Y, Jiang X, Huang J, et al. Reliability of the superficial venous
drainage of the radial forearm free flaps in oral and maxillofacial
reconstruction. Microsurgery 28:243-7, 2008
Medard de Chardon V, Balaguer T, Chignon-Sicard B, Riah Y, Ihrai T,
Dannan E, Lebreton E: The radial forearm free flap: a review of
microsurgical options. J Plast Reconstr Aesthet Surg 62:5-10, 2009
Mühlbauer W, Herndl E, Stock W: The forearm flap. PlastReconstr
Surg 70(3):336-44, 1982
Netscher DT, Sharma S, Alford EL, Thornby J, Leibman NS: Superficial
versus deep: options in venous drainage of the radial forearm free
flap. Ann Plast Surg 36:536-41, 1996
Niranjan NS, Watson DP: Reconstruction of the cheek using a "suspended"
radial forearm free flap. Br J Plast Surg 43(3):365-6, 1990
O’Brien CJ, Lee KK, Castle GK, Hughes CJ: Comprehensive treatment
strategy for oral and oropharyngeal cancer. AmJ Surg. 164:582-6,
1992
Percival NJ, Sykes PJ, Earley MJ: Free flap surgery: the Welsh Regional
Unit experience. Br J Plast Surg. 42:435-40, 1989
Rohleder NH, Wolff KD, Hölzle F, Wagenpfeil S, Wales CJ, Hasler RJ,
Kesting MR: Secondary maxillofacial reconstruction with the radial
forearm free flap: a standard operating procedure for the venous
microanastomoses. Ann Surg Oncol 18(7):1980-7, 2011
Schusterman MA, Miller MJ, Reece GP, et al: A single centre experience
with 308 free flap repairs of head and neck defects. Plast Reconstr
Surg 93:472-8, 1994
Smith GI, O’Brien CJ, Choy ET, et al: Clinical outcome and technical
aspects of 263 radial forearm free flaps used in reconstruction of
the oral cavity. Br J Oral Maxillofac Surg. 43:199-204, 2005
Song R, Gao Y, Song Y, Yu Y, Song Y.: The forearm flap. ClinPlast Surg
9(1):21-6, 1982
Soutar DS, Scheker LR, Tanner NSB, McGregor IA: The radial forearm
flap. A versatile method for intra-oral reconstruction. Br J Plast
Surg. 36:1-8, 1983
Soutar DS, McGregor IA: The radial forearm flap in intraoral reconstruction:
the experience of 60 consecutive cases. Plast Reconstr
Surg. 78:1-8, 1986
Thoma A, Archibald S, Jackson S, Young JE: Surgical patterns of venous
drainage of the free forearm flap in head and neck reconstruction.
Plast Reconstr Surg. 93:54-9, 1994
Vaughan ED. The radial forearm free flap in orofacial reconstruction:
personal experience in 120 consecutive cases. J Craniomaxillofac
Surg 18:2-7, 1990
Vaughan ED: The radial forearm in orofacial reconstruction. Int J Oral
Maxillofac Surg 23:194-204, 1994
Wong CH, Wei FC: Microsurgical free flap in head and neck reconstruction.
Head Neck 32:1236-45, 2010
Wolff K-D, Hölzle F: Raising of Microvascular flaps. A systematic approach.
2nd Ed, Springer 2011, pp 1-20
Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, He SP: Forearm free
skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg
1997 50(3):162-5, 1997
Francis DO, Stern RE, Zeitler D, Izzard M, Futran ND. Analysis of free
flap viability based on recipient vein selection. Head Neck
31:1354–9, 2009
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