eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Free Tissue Transfer, Osteocutaneous Radial Forearm Flap: Multimedia

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

Multimedia

Planned fasciocutaneous paddle drawn with a surgi...Media file 1: Planned fasciocutaneous paddle drawn with a surgical pen on the volar aspect of the donor forearm. Note the ulnar bias to the skin paddle with the palpated radial artery (RA) and ulnar artery (UA) marked.
Planned fasciocutaneous paddle drawn with a surgi...

Planned fasciocutaneous paddle drawn with a surgical pen on the volar aspect of the donor forearm. Note the ulnar bias to the skin paddle with the palpated radial artery (RA) and ulnar artery (UA) marked.

Subfascial dissection is performed under the fasc...Media file 2: Subfascial dissection is performed under the fasciocutaneous paddle in the medial to lateral direction. The flexor carpi radialis, palmaris longus, and flexor carpi radialis tendons are preserved as the surgeon moves medial to lateral. The pedicle is preserved just lateral to the flexor carpi radialis tendon. Care is taken to protect the sometimes superficial ulnar pedicle just lateral to the flexor carpi ulnaris tendon distally.
Subfascial dissection is performed under the fasc...

Subfascial dissection is performed under the fasciocutaneous paddle in the medial to lateral direction. The flexor carpi radialis, palmaris longus, and flexor carpi radialis tendons are preserved as the surgeon moves medial to lateral. The pedicle is preserved just lateral to the flexor carpi radialis tendon. Care is taken to protect the sometimes superficial ulnar pedicle just lateral to the flexor carpi ulnaris tendon distally.

Subfascial dissection is performed in a lateral-t...Media file 3: Subfascial dissection is performed in a lateral-to-medial direction under the fasciocutaneous paddle. The superficial radial nerve is shown with the vessel loop and is preserved. Care is taken near the medial border of the brachioradialis tendon to preserve the radial artery pedicle. The proximal linear incision from the fasciocutaneous paddle to the antebrachial fossa has been elevated.
Subfascial dissection is performed in a lateral-t...

Subfascial dissection is performed in a lateral-to-medial direction under the fasciocutaneous paddle. The superficial radial nerve is shown with the vessel loop and is preserved. Care is taken near the medial border of the brachioradialis tendon to preserve the radial artery pedicle. The proximal linear incision from the fasciocutaneous paddle to the antebrachial fossa has been elevated.

The horizontal osteotomy is performed using the o...Media file 4: The horizontal osteotomy is performed using the oscillating saw. Fifty percent of the radius circumference is harvested proximally to distally.
The horizontal osteotomy is performed using the o...

The horizontal osteotomy is performed using the oscillating saw. Fifty percent of the radius circumference is harvested proximally to distally.

An oscillating saw is used to make the concave be...Media file 5: An oscillating saw is used to make the concave beveled edges on both ends of the harvested radius bone graft. This step is performed on the medial side of the intermuscular septum. This photograph shows the proximal osteotomy. In order to maintain the donor radius strength, past-pointing the horizontal incision is prevented by placing a metal ruler in the previously made osteotomy.
An oscillating saw is used to make the concave be...

An oscillating saw is used to make the concave beveled edges on both ends of the harvested radius bone graft. This step is performed on the medial side of the intermuscular septum. This photograph shows the proximal osteotomy. In order to maintain the donor radius strength, past-pointing the horizontal incision is prevented by placing a metal ruler in the previously made osteotomy.

Model of proper prophylactic plating of the donor...Media file 6: Model of proper prophylactic plating of the donor radius arm. The arrows point to the concave beveled edges' osteotomies. Note that the plate is placed partially over the defect and partially over the remaining radius bone. Usually, 2 bicortical screws are placed distally, while 3 bicortical screws are placed proximally.
Model of proper prophylactic plating of the donor...

Model of proper prophylactic plating of the donor radius arm. The arrows point to the concave beveled edges' osteotomies. Note that the plate is placed partially over the defect and partially over the remaining radius bone. Usually, 2 bicortical screws are placed distally, while 3 bicortical screws are placed proximally.

The plate is placed on the dorsal aspect of the d...Media file 7: The plate is placed on the dorsal aspect of the donor radius, and bicortical screws are placed both distally and proximally. The brachioradialis tendon can be retracted to facilitate screw and plate placement.
The plate is placed on the dorsal aspect of the d...

The plate is placed on the dorsal aspect of the donor radius, and bicortical screws are placed both distally and proximally. The brachioradialis tendon can be retracted to facilitate screw and plate placement.

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

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].

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  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].

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Further Reading

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

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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