If there is displacement widening of fracture line after 6 weeks surgery needed after immobilization active rom exercises to forearm, wrist and thumb performed 68 x daily wrist and thumb static splint with wrist in neutral should be. Only later, the pedicled flap based on the retrograde flow from the palmar arch was described by biemer and lu 19, 24. This redman training forearm shield gives you extra. This flap is considered to be one of the most reliable and versatile flaps for both pedicle and free flap reconstruction. Harii described the use of a tubed fasciocutaneous free flap for pharyngoesophageal reconstruction in 1985. Progress of rotator cuff free weight program independently. This chapter talks about free tissue transfer indicated for the replacement of moderate to large soft tissue defects associated with ablative wounds. The radial forearm flap is usually used in reconstruction of the mutilated hand as a reverse pedicled flap, but occasionally, a free radial forearm flap can be harvested from the contralateral forearm. Currently, we prefer this flap for reconstruction of defects involving the tongue, intraoral soft tissue, oropharynx, soft. This piece of writing comprised all the detail about harvesting radial forearm free flap, advantages.
Tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly. We report our experience with this form of reconstruction in 10 consecutive patients surgically treated between 1992 and 1998 at the department of otolaryngology, head and neck. A radial forearm free flap is one way of filling a hole which is left when a cancer has been removed. Use of the radial forearm microvascular freeflap graft for. Nov 22, 2011 radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Micro vascular free flaps used in head and neck reconstruction. The dominant pedicle is the radial artery, with venous outflow through the dual system of the venae. This redman training forearm shield gives you extra protection for accuracy drills. The peninsular mucoperiosteal flaps are based on the posterior greater palatine neurovascular bundles, and they can. Since its introduction in the literature 30 years ago,v the crossfinger flap has in the experience of many authors apr 02, 2016 a distally based radial forearm fasciocutaneous flap, from the radial aspect of the middlethird forearm and nourished by a perforator from the middle radial artery, was designed to cover the defect.
Department developed and released the cantonese spoken word recognition test canswort, a validated assessment tool for spoken word recognition ability in cantonese and applicable to paediatric population as young as 3 years of age, with hearing sensitivity ranging from profound impairment to typical, and with or without using hearing devices. You may be thinking that this is a little bit big for the actual nipple itself, but i typically make this at least twice the size because they all shrink down by about 50% over times. Indications for the use of the procedure the radial forearm flap is a reliable, versatile flap, based on the radial artery, that can be applied to reconstruction of many anatomic structures in. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. An atlas of microsurgery techniques and principles. During this entire protocol, your leg should not bear any of your body weight. Brachial lifting using the balanced triplevector btv. It has since become a work horse for soft tissue replacement in. A distally based radial forearm fasciocutaneous flap, from the radial aspect of the middlethird forearm and nourished by a perforator from the middle radial artery, was designed to cover the defect. Doppler ultrasound was used in all cases to evaluate the vascular status of the flap. The composite radial forearmpalmaris longus tendon free flap has been described by sakai et al, 3 as a new technique for reconstructing total lip and chin defects. May 25, 2017 tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly dependent on venous drainage. Speech and swallowing following radial forearm flap. Return to sports or work at months postop without restrictions 2.
Use of the radial forearm microvascular freeflap graft. The chinese forearm flap is vascularized by the radial artery and may be used as an island or a free flap. Radial forearm versus the ulnar forearm free flap full. Reversed radial forearm flaps were harvested in 15 cases. The role of the implantable doppler probe in free flap surgery. Revisiting radial forearm free flap for successful venous. Micro vascular free flaps used in head and neck reconstruction certified fixed orthodontic courses by indian dental academy. Indian dental academy leader in continuing dental education 2.
Several types of free flaps can be used to restore defects within the oral cavity and orohypopharynx anterolateral thigh flap, rectus abdominis musculocutaneous flap, free deltoid flap, etc. The anatomy of the radial forearm flap initially described by chinese authors was studied in 25 dissections. The radial forearm flap was developed in china in the early 1970s and originally published by yang as a free flap. Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal. The test arm should slightly hang off the edge of the table. Outcomes of the osteocutaneous radial forearm free flap. A pedicled anterior lateral thigh flap was raised and advanced into the defect after the contracture had been. A recommended protocol for the immediate postoperative care of lower extremity freeflap reconstructions christine rohde, brittny williams howell, gregory m. Radial forearm free flap iowa head and neck protocols.
Radial free forearm flap rfff surgical technique vula. The radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Radial forearm free flap free download as powerpoint presentation. A fifteenyearold female patient presented with a severe bilateral groin contracture for the last 8 years. Again, the flap must first be lifted carefully to separate it and allow safe traction fig. There is acceptable form and functional restoration with minimal donor site morbidity. Used as an island flap, the pitfalls of the microsurgical procedures required for a free. This chapter focuses on the radial forearm flap technique and discusses the ulnar forearm flap as an alternate technique for forearm flap reconstruction. Pedicled anterior lateral thigh flap in managing a. Drainage methods include combining both systems or using one alone. Reconstruction of the cranial base after resection of complex lesions requires creation of both a vascularized barrier to cerebrospinal fluid csf leakage and tailored filling of operative defects. The patient lies prone with forearm and wrist in neutral thumb side down. Loss of tissue resulting from cancer ablation or debridement of infected tissues or secondary to trauma provides the reconstructive surgeon with various challenges.
The therapist stabilizes the forearm against the table with one hand and uses other hand to apply downward resistance toward wrist abduction. Tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly dependent on venous drainage. Jul 26, 2011 complex wounds of the hand and vital structures are important to reconstruct. For flap b, we repeat the process applied to flap a, by applying the desired upward traction. Jun 04, 2016 this chapter focuses on the radial forearm flap technique and discusses the ulnar forearm flap as an alternate technique for forearm flap reconstruction. In each flap the incision made along the cleft margin joins the lateral relaxing incision at the alveolar margin anteriorly. Skin graft must preserve paratenon layer osteocutaneous flaps radius fracture. Free radial forearm flap to electrical burn of hand and thumb click on each image for a larger picture high voltage electrical burn to the thumb and distal forearm. The radial forearm flap was first described in 1978 by yang et al. Velopharyngeal function was analysed in eight patients following microsurgical reconstruction of defects of between 50 and 100% of the soft palate. Radial forearm free flap atlas of operative oral and. Doppler ultrasound was used in all cases to evaluate the vascular. Although forearm free flaps are frequently performed, there is insufficient prospective data looking at the morbidity of the radial compared to ulnar forearm free flaps.
Importance limited donor and recipient site complications support the osteocutaneous radial forearm free flap ocrfff for mandibular reconstruction as a useful option for singlestage mandibular reconstruction objective to examine and report longterm outcomes and complications at the donor and recipient sites for patients undergoing the. Traditionally, the fibula free flap has been the mainstay for mandibular reconstruction, with its increased length and quality of bone stock. Free radial forearm flap for near total degloving finger. The appropriate design of a rotation flap often involves the creation of long incision lines. Novel technique for the direct closure of the radial forearm flap. The forearm flap has been used for just about everything imaginable in the area of head and neck reconstruction. A recommended protocol for the immediate postoperative.
Oct 29, 20 micro vascular free flaps used in head and neck reconstruction certified fixed orthodontic courses by indian dental academy 1. Large oval design is contoured for comfortable handling. Surgical technique ottie van zyl the radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Outcomes of the osteocutaneous radial forearm free flap for. Radial forearm free flap postoperative instructions. Manual muscle testing of the wrist university of west. Harvest of a radial forearm fasciocutaneous free flap variant image id. It presents a list of the radial forearm flap layers, and explains the radial forearm flap technique. Nowadays, the technique for harvesting is standardized, while reconstruction of the forearm donor site defect is somewhat controversial. You may not embed one of our images on your web page without a link back to our site. Watch a live nipple reconstruction using the star flap. Radial forearm versus the ulnar forearm free flap full text. The reversed radial forearm flap is a versatile option for hand reconstruction.
Today, it is mainly used as free flap especially when thin and pliable soft tissue coverage. Complications of free radial forearm flap transfers for. Harvest of a radial forearm fasciocutaneous free flap. Radial forearm free flap rfff is a versatile reconstructive method, first described by yang et al. Radial forearm free flap musculoskeletal system medicine. The radial forearm free flap should not be used for every head and neck defect. Radial forearm flap preoperative considerations allen test tests viability of palmar arch system no ivs blood draws in donor arm. Oct 14, 2009 the pedicled radial forearm flap is a time proven procedure that offers reliable coverage in this area without the need of advanced microsurgical expertise.
Indications the forearm flap has been used for just about everything imaginable in the area of head and neck reconstruction. The crossfinger flap an established reconstructive procedure david a. The radial forearm free flap is the preferred technique for total phalloplasty. Ab the unique attributes of the radial forearm flap for head and neck reconstruction make it a primary choice from the reconstructive ladder. The subscapular artery and veins of the combined flap were anastomosed to the radial artery and veins of the forearm. In the fifth patient, 2 simultaneous free radial forearm flaps were used for both upper and lower lip and bilateral buccal mucosal reconstruction. Complex wounds of the hand and vital structures are important to reconstruct. It has since become a workhorse for soft tissue replacement in head. When this socalled chinese flap was originally described by yang et al. The radial forearm consists of thin, pliable skin that can be molded in three dimensions and transferred as a sensate flap, making it ideal for most head and neck reconstructions. The reliability of this flap, regardless of the incisional sites used, was demonstrated by the constant presence of several arterioles supplying the cutaneous tissue. If a rotation flap with a very short arc is designed, the width of the secondary defect created upon flap rotation will be proportionally larger, and the potentials for unacceptable secondary motion and inappropriately high wound closure tensions are magnified. Download as an information leaflet pdf radial forearm flap. They should be covered as soon as possible in order to maintain the function of the hand.
It can be used to replace large parts of the mouth and. Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Currently, we prefer this flap for reconstruction of defects involving the tongue, intraoral soft tissue, oropharynx, soft palate, hypopharynx, cervical esophagus, and selected cutaneous defects. A single patient in this group had a partial brachioradialis muscle flap raised as chimeric component to the composite radial forearm flap. Radial forearm free flap pharyngoesophageal reconstruction. Treatment of complex hand trauma using the distal ulnar. Owing to its long pedicle, pliable soft tissue, and ease of dissection, the radial forearm flap is a primary. Reconstruction of total lower lip and chin defects using the. Complications of free radial forearm flap transfers for head. The patient did not complain about the appearance and function of the left forearm.
Free flaps did not, however, become widely used for hypopharyngeal reconstruction until after the refinement of microvascular techniques during the 1970s. Dissertation titles oral and maxillofacial surgery. The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap. This is called a star flap, as you can kind of see by the shapes of it. Some patients will have a tracheotomy, it is more common if having a. The radial forearm free flap rfff was introduced by yang et al. Pedicled anterior lateral thigh flap in managing a bilateral. The skin of the volar forearm provides relatively thin and reliable coverage for a. Department of otorhinolaryngology, head and neck surgery ent. Lower legfoot free flap protocol in order to allow for proper healing and to prevent excess swelling following your leg surgery, you must follow a progressive leg dangle protocol before you can return to having your leg down and on the ground. The radial forearm free flap and the ulnar forearm free flap are both welldescribed procedures used for free tissue transfer in reconstructive surgery. Jul 06, 2018 the radial forearm free flap and the ulnar forearm free flap are both welldescribed procedures used for free tissue transfer in reconstructive surgery. In 1978, a fasciocutaneous free flap from the volar aspect of the forearm and pedicled on the radial artery was first used in china. Department of otorhinolaryngology, head and neck surgery.
The radial forearm fasciocutaneous free flap was used in all cases. Rfff has two major venous outflow systems, superficial and deep vein. The outcome of reconstruction was analysed by patient questionnaire and with standardised tests of speech and swallowing function. The main symptom of forearm splints is a dull ache between the extensor muscles crossing the back of the forearm true crossing the volar aspect of the carpal bones is the transverse carpal ligament, which serves as the roof to the carpal tunnel through which the median nerve passes. Reconstruction of total lower lip and chin defects using. Abstract background the donor site defect remains the major disadvantage of the radial forearm free flap rfff.
Revisiting radial forearm free flap for successful venous drainage. Shaji thomas ms,mch additional professor division of surgical oncology regional cancer centre trivandrum 2. Since 1992, we have carried out 38 frff transfers in 37 patients for reconstruction after head and neck cancer ablative surgery. Flap choice should be dictated by the needs of the patient and those of the site to be reconstructed. The radial forearm free flap is a viable reconstructive option for tongue defects especially where a thin, pliable flap is needed. Volumetric analysis of quantum of corticocancellous bone in anterior iliac of pediatric patients undergoing bilateral cleft alveolus repair, with finite element analysis correlation a pilot study dr.
Regional cancer centre, trivandrum life beyond cancer reconstructive options after head and neck cancer resections dr. Three attempts to release the contracture with split thickness skin grafts had been done without success. Radial forearm flap british association of oral and. The distal thumb and thenar musles were burned beyond salvage. The radial forearm free flap rfff is the most commonly. After 1 month, the radial forearm free flap reconstruction in the tongue had acceptable appearance and good tongue mobility with intelligible speech. Wide circumferential forearm skin defect covered with. Radial forearm free flap is regularly used in reconstruction of oral and maxillofacial region after ablative cancer surgeries. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. Radial forearm flap an overview sciencedirect topics. A pedicled anterior lateral thigh flap was raised and advanced into the defect after the contracture had been released. Despite several alternatives and an increasing acceptance of free tissue transfers, the pedicled radial forearm flap can still be the procedure of choice under special circumstances. The free radial forearm flap frff has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. It is one of the most common ways of replacing tissue in the head and neck, particularly after mouth cancers have been removed.
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