Osteocutaneous Radial Forearm Flap Free Tissue Transfer Workup

  • Author: Terance (Terry) Ted Tsue, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 7, 2012
 

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.
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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  • Angiography of the forearm to determine adequate vascular anatomy has been replaced by noninvasive studies, such as Doppler photoplethysmography, which is used when Allen test results are equivocal.
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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.

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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, FACS  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, University of Kansas Medical Center

Yelizaveta (Lisa) Shnayder, MD, FACS 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 Southwest Oncology Group

Disclosure: Nothing to disclose.

Oleg N Militsakh, MD  Assistant Professor, Department of Otolaryngology, Division of Head and Neck Surgery and Facial Plastic Reconstruction, University of Nebraska Medical Center; Consulting Surgeon in Head and Neck Surgery, Nebraska Methodist Hospital

Oleg N Militsakh, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, and American Society for Reconstructive Microsurgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Anthony P Sclafani, MD  Director of Facial Plastic Surgery and Surgeon Director, 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: Contura None Board membership; Aesthetic Factors, Inc. Salary Consulting; Aesthetic Factors, Inc. Grant/research funds Independent contractor

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. Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX. Forearm free skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg. Apr 1997;50(3):162-5. [Medline].

  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. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  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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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 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-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 oscillating saw. Fifty percent of the radius circumference is harvested proximally to distally.
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 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 donor radius, and bicortical screws are placed both distally and proximally. The brachioradialis tendon can be retracted to facilitate screw and plate placement.
 
 
 
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