Radial Forearm Tissue Transfer Workup

  • Author: Mark K Wax, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 22, 2012
 

Laboratory Studies

  • CBC count
  • Type and screen
  • Chemistry panel
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mark K Wax, MD  Professor and Program Director, Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University; Service Chief, Department of Surgery, Section of Otolaryngology, Veterans Affairs Medical Center

Mark K Wax, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Canadian Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine P Winslow, MD  Consulting Surgeon, Winslow Facial Plastic Surgery, LLC

Catherine P Winslow, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, and American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Terance (Terry) Ted Tsue, MD  Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

  1. 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. Oct 1998;102(5):1544-8. [Medline].

  2. Daya M, Nair V. Free radial forearm flap lip reconstruction: a clinical series and case reports of technical refinements. Ann Plast Surg. Apr 2009;62(4):361-7. [Medline].

  3. Lane JC, Swan MC, Cassell OC. Closure of the Radial Forearm Donor Site Using a Local Hatchet Flap: Analysis of 45 Consecutive Cases. Ann Plast Surg. Mar 6 2012;[Medline].

  4. Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg. Mar 16 2012;[Medline].

  5. Boyd B, Mulholland S, Gullane P, et al. Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense?. Plast Reconstr Surg. Jun 1994;93(7):1350-9; discussion 1360-2. [Medline].

  6. Brown MT, Couch ME, Huchton DM. Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest. Arch Otolaryngol Head Neck Surg. Dec 1999;125(12):1371-4. [Medline].

  7. Funk GF, Valentino J, McCulloch TM, Graham SM, Hoffman HT. Anomalies of forearm vascular anatomy encountered during elevation of the radial forearm flap. Head Neck. Jul-Aug 1995;17(4):284-92. [Medline].

  8. Ho T, Couch M, Carson K, Schimberg A, Manley K, Byrne PJ. Radial forearm free flap donor site outcomes comparison by closure methods. Otolaryngol Head Neck Surg. Feb 2006;134(2):309-15. [Medline].

  9. Kim JH, Rosenthal EL, Ellis T, Wax MK. Radial forearm osteocutaneous free flap in maxillofacial and oromandibular reconstructions. Laryngoscope. Sep 2005;115(9):1697-701. [Medline].

  10. Smith AA, Bowen CV, Rabczak T, Boyd JB. Donor site deficit of the osteocutaneous radial forearm flap. Ann Plast Surg. Apr 1994;32(4):372-6. [Medline].

  11. Urken ML, Cheney ML, Sullivan MJ. Radial forearm free flaps. In: Atlas of Regional and Free Flaps for Head and Neck Reconstruction. Philadelphia, Pa: Lippincott-Raven; 1995.

  12. Urken ML, Weinberg H, Vickery C, Biller HF. The neurofasciocutaneous radial forearm flap in head and neck reconstruction: a preliminary report. Laryngoscope. Feb 1990;100(2 Pt 1):161-73. [Medline].

  13. Werle AH, Tsue TT, Toby EB, Girod DA. Osteocutaneous radial forearm free flap: its use without significant donor site morbidity. Otolaryngol Head Neck Surg. Dec 2000;123(6):711-7. [Medline].

 
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Harvesting the radial forearm flap in the subfascial plane is relatively safe. A superficial ulnar system is occasionally encountered, and care must be taken not to transect this. Here, a very superficial ulnar artery is observed.
A preoperative Allen test can identify abnormal palmar arch anatomy. Here, a pale thenar region is observed following release of the ulnar artery. An ulnar flap was performed instead.
The radial forearm flap can be harvested as an osteocutaneous flap. Harvesting the bone in a keel shape and plating of the radius can help prevent postoperative fractures.
 
 
 
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