eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Free Tissue Transfer, Osteocutaneous Radial Forearm Flap: Workup

Author: 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
Coauthor(s): Yelizaveta (Lisa) Shnayder, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, University of Kansas Medical Center; Douglas A Girod, MD, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine; Professor, Department of Hearing and Speech, School of Allied Health, University of Kansas; Oleg N Militsakh, MD, Fellow, Oncologic Head and Neck and Microvascular Reconstructive Surgery, Clinical Instructor, Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Jan 7, 2008

Workup

Laboratory Studies

  • Order electrolyte panel tests. Profound diabetes mellitus or renal failure may affect the success of free tissue transfer.
  • Obtain a complete blood cell count. Polycythemia and extreme anemia can affect flap success.
  • Measure the prothrombin time and/or activated partial thromboplastin time. The presence of coagulopathies may be a contraindication to using a free flap.
  • Order liver function tests. Liver failure is a contraindication to using a free flap. Unexplained abnormalities warrant a more extensive metastatic workup.

Imaging Studies

  • Plain radiographs of the forearm are required in cases of congenital deformities or when previous surgery or trauma of the forearm has occurred.
  • Angiography of the forearm to determine adequate vascular anatomy has been replaced by noninvasive studies, such as Doppler photoplethysmography, which is used when Allen test results are equivocal.

Other Tests

Perform the subjective Allen test in both forearms. This test ensures adequate hand perfusion by the ulnar artery and detects radial artery thrombosis. If results of the subjective Allen test are equivocal, use an objective Allen test. This technique uses Doppler photoplethysmography to detect digit perfusion under radial and ulnar artery compression scenarios. This study is most useful in showing adequate hand and digit perfusion when subjective Allen test findings are equivocal.

More on Free Tissue Transfer, Osteocutaneous Radial Forearm Flap

Overview: Free Tissue Transfer, Osteocutaneous Radial Forearm Flap
Workup: Free Tissue Transfer, Osteocutaneous Radial Forearm Flap
Treatment: Free Tissue Transfer, Osteocutaneous Radial Forearm Flap
Follow-up: Free Tissue Transfer, Osteocutaneous Radial Forearm Flap
Multimedia: Free Tissue Transfer, Osteocutaneous Radial Forearm Flap
References
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References

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  2. 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].

  3. Schusterman MA, Reece GP, Kroll SS, Weldon ME. Use of the AO plate for immediate mandibular reconstruction in cancer patients. Plast Reconstr Surg. Oct 1991;88(4):588-93. [Medline].

  4. Arden RL, Rachel JD, Marks SC, Dang K. Volume-length impact of lateral jaw resections on complication rates. Arch Otolaryngol Head Neck Surg. Jan 1999;125(1):68-72. [Medline].

  5. Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. Jun 2000;105(7):2331-46; discussion 2347-8. [Medline].

  6. Chepeha DB, Moyer JS, Bradford CR, Prince ME, Marentette L, Teknos TN. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects. Arch Otolaryngol Head Neck Surg. Jun 2005;131(6):513-7. [Medline].

  7. 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].

  8. Clark S, Greenwood M, Banks RJ, Parker R. Fracture of the radial donor site after composite free flap harvest: a ten-year review. Surgeon. Oct 2004;2(5):281-6. [Medline].

  9. Hatoko M, Tanaka A, Iioka H, Niitsuma K, Tada H. Use of calcium phosphate cement for bone defect after harvesting radial forearm osteocutaneous flap. Ann Plast Surg. Sep 2004;53(3):245-9. [Medline].

  10. Blackwell KE, Buchbinder D, Urken ML. Lateral mandibular reconstruction using soft-tissue free flaps and plates. Arch Otolaryngol Head Neck Surg. Jun 1996;122(6):672-8. [Medline].

  11. Matthews RN, Fatah F, Davies DM, Eyre J, Hodge RA, Walsh-Waring GP. Experience with the radial forearm flap in 14 cases. Scand J Plast Reconstr Surg. 1984;18(3):303-10. [Medline].

  12. Militsakh ON, Wallace DI, Kriet JD, Tsue TT, Girod DA. The role of the osteocutaneous radial forearm free flap in the treatment of mandibular osteoradionecrosis. Otolaryngol Head Neck Surg. Jul 2005;133(1):80-3. [Medline].

  13. Militsakh ON, Werle A, Mohyuddin N, Toby EB, Kriet JD, Wallace DI, et al. Comparison of radial forearm with fibula and scapula osteocutaneous free flaps for oromandibular reconstruction. Arch Otolaryngol Head Neck Surg. Jul 2005;131(7):571-5. [Medline].

  14. Nakatsuka T, Harii K, Yamada A, Ueda K, Ebihara S. Dual free flap transfer using forearm flap for mandibular reconstruction. Head Neck. Nov-Dec 1992;14(6):452-8. [Medline].

  15. Nuckols DA, Tsue TT, Toby EB, Girod DA. Preoperative evaluation of the radial forearm free flap patient with the objective Allen's test. Otolaryngol Head Neck Surg. Nov 2000;123(5):553-7. [Medline].

  16. Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg. Jul 1986;78(1):1-8. [Medline].

  17. Soutar DS, Scheker LR, Tanner NS, McGregor IA. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg. Jan 1983;36(1):1-8. [Medline].

  18. Tsue TT, Desyatnikova SS, Deleyiannis FW, Futran ND, Stack BC Jr, Weymuller EA Jr. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg. Jul 1997;123(7):731-7. [Medline].

  19. Urken ML, Weinberg H, Vickery C, Aviv JE, Buchbinder D, Lawson W, et al. The combined sensate radical forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects. Laryngoscope. May 1992;102(5):543-58. [Medline].

  20. Vaughan ED. The radial forearm free flap in orofacial reconstruction. Personal experience in 120 consecutive cases. J Craniomaxillofac Surg. Jan 1990;18(1):2-7. [Medline].

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Further Reading

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Keywords

osteocutaneous radial forearm flap, radial forearm osteocutaneous free flap, radial forearm osteocutaneous microvascular flap, osteocutaneous radial forearm free tissue transfer, fasciocutaneous radial forearm free flap, FCRFFF, RFFF, OCRFFF, head and neck reconstruction, head and neck surgery, head and neck reconstructive surgery, head and neck cancer, head and neck extirpative surgery

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

Yelizaveta (Lisa) Shnayder, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, University of Kansas Medical Center
Yelizaveta (Lisa) Shnayder, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Douglas A Girod, MD, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine; Professor, Department of Hearing and Speech, School of Allied Health, University of Kansas
Douglas A Girod, 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 Medical Association, Society of University Otolaryngologists-Head and Neck Surgeons, and Southwestern Oncology Group
Disclosure: Nothing to disclose.

Oleg N Militsakh, MD, Fellow, Oncologic Head and Neck and Microvascular Reconstructive Surgery, Clinical Instructor, Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina
Oleg N Militsakh, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Anthony P Sclafani, 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, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, 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, Department of Otolaryngology-Head and Neck Surgery, 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: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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