RESUMO
BACKGROUND: This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN). METHODS: Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis. RESULTS: Fifty-six patients were included (OC-RFFF: 38; FFF: 18). Significantly more OC-RFFF patients had lateral mandible defects (94% vs. 61%, p = 0.0014). There were significantly more patients with exposed intraoral bone in the OC-RFFF group (23% vs. 0% p = 0.02), but no significant differences in hardware complications or flap failure. Donor site partial skin graft loss was more common in the FFF group (22% vs. 2.6%, p = 0.016), but no other significant differences in donor site morbidity were seen. Bivariable analysis showed no impact of flap type, tobacco/alcohol use, diabetes, or hypothyroidism on postoperative complications. Sixty percent of OC-RFFF, and 67% of FFF, patients resumed an oral diet after surgery. Oral diet was not impacted by flap type (OR = 0.769, 95% CI = 0.201-2.706, p = 0.688). CONCLUSION: The OC-RFFF is an acceptable option in the reconstruction of ORN involving the lateral mandible, though there is increased risk of bone exposure. These findings can help guide surgeon selection of microvascular free flap donor sites and appropriate patient counseling.
Assuntos
Fíbula , Antebraço , Retalhos de Tecido Biológico , Osteorradionecrose , Humanos , Osteorradionecrose/cirurgia , Osteorradionecrose/etiologia , Retalhos de Tecido Biológico/transplante , Masculino , Estudos Retrospectivos , Feminino , Fíbula/transplante , Pessoa de Meia-Idade , Antebraço/cirurgia , Idoso , Doenças Mandibulares/cirurgia , Doenças Mandibulares/etiologia , Resultado do Tratamento , Reconstrução Mandibular/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica/métodos , AdultoRESUMO
The osteocutaneous radial forearm free flap (OCRFFF) is a versatile flap with the ability to reconstruct complex defects. We detail the techniques necessary to harvest an OCRFFF, including an outline on making 90-degree osteotomies to maximize bone harvest. In this pictorial essay, we provide illustrations of the anatomy and surgical techniques necessary for OCRFFF harvest. Detailed discussion is provided on how to protect the perforators to the bone and the approach to making osteotomies in a 90-degree fashion. The approach for prophylactic plating of the radius to prevent radius fractures is outlined. A case presentation on the real-life utilization of this flap is included. The OCRFFF is an excellent head and neck reconstructive option. While there are limitations to its use for patients requiring dental rehabilitation or long/anterior mandibular defects, for the right patient and indication it has shown great success in reconstructive efforts.
Assuntos
Antebraço , Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Feminino , Humanos , Transplante Ósseo/métodos , Carcinoma de Células Escamosas/cirurgia , Antebraço/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Osteotomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Rádio (Anatomia)/cirurgia , Coleta de Tecidos e Órgãos/métodos , Idoso de 80 Anos ou maisRESUMO
The osteocutaneous radial forearm (OCRFF) is a versatile free flap option for bony defects of the head and neck, given the thinness and pliability of the forearm cutaneous paddle, pedicle length, reliability, lack of atherosclerosis, and functional concerns common to other osseous donor sites. The OCRFF was once associated with a high risk of radial fracture, in addition to concerns about the quality and durability of bone stock for osseous reconstruction, particularly for the mandible. Following the introduction of prophylactic plating of the radius, the incidence of symptomatic radial fracture has drastically decreased. Furthermore, modifications of the bony osteotomies and other evolutions of this flap harvest have increased the use of the OCRFF throughout the head and neck. Despite these advantages, the OCRFF is not widely utilized by microvascular reconstructive surgeons due to perceived limitations and risks. Herein, we present a multidisciplinary, contemporary review of the harvest technique, outcomes, and perioperative management for the OCRFF.
Assuntos
Antebraço , Retalhos de Tecido Biológico , Humanos , Antebraço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Rádio (Anatomia)/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgiaRESUMO
BACKGROUND: Historical concerns over bone resorption and malunion of the osteocutaneous radial forearm free flap (OCRFFF) limited its widespread adoption for head and neck reconstruction, despite lack of outcomes data evaluating this notion. METHODS: A retrospective cohort study was performed including patients 18 years or older who underwent reconstruction of the mandible using an OCRFFF. Linear modeling and logistic regression were used to evaluate the change in bone volume and union over time. RESULTS: One hundred and twenty-one patients were included in the study. A mixed effects linear model incorporating age, sex, treatment type, and number of bone segments did not demonstrate a significant loss of bone volume over time. A logistic regression model identified lack of adjuvant treatment and time to be significantly associated with complete union. CONCLUSION: This study supports that the OCRFFF is a stable form of osseus reconstruction for defects of the head and neck.
Assuntos
Carcinoma de Células Escamosas , Retalhos de Tecido Biológico , Reconstrução Mandibular , Procedimentos de Cirurgia Plástica , Carcinoma de Células Escamosas/cirurgia , Antebraço/cirurgia , Retalhos de Tecido Biológico/cirurgia , Humanos , Mandíbula/cirurgia , Rádio (Anatomia)/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Resections involving oral cavity mucosa, bone, and skin present a unique challenge. Optimizing outcomes often requires technically demanding reconstruction. The purpose of this study is to evaluate outcomes of several reconstructive approaches for patients with composite through-and-through defects, with a focus on the osteocutaneous radial forearm free flap (RFFF). METHODS: We conducted a retrospective evaluation of the cohort of patients treated for composite through-and-through defects with cutaneous involvement who underwent free flap reconstruction from August 2012 through October 2015. RESULTS: Seventeen patients received a single flap (12 cases of osteocutaneous RFFF), whereas 10 patients underwent a combination of flaps. Complication rates and functional outcomes were favorable in patients who underwent osteocutaneous RFFFs. The supraclavicular artery island flap (SCAIF) was used as a second flap in 3 cases. CONCLUSION: The osteocutaneous RFFF provides a valuable reconstructive option for complex composite resection defects involving skin. When 2 flaps are required, the SCAIF is a viable alternative to a second free flap or pectoralis flap.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Neoplasias Bucais/cirurgia , Osteorradionecrose/cirurgia , Procedimentos de Cirurgia Plástica , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Mandíbula , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Osteorradionecrose/patologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The osteocutaneous radial forearm free flap (RFFF) is a versatile flap primarily used to reconstruct composite defects involving the mandible. The purpose of this study was to describe our experience with this flap for nonmandible reconstruction. METHODS: All patients undergoing nonmandible osseous reconstruction with free-tissue transfer were reviewed. Patients with osteocutaneous RFFF reconstructions were evaluated. The retrospective review of all osteocutaneous RFFFs was performed from 1998 to 2014. RESULTS: One hundred forty-two nonmandible osseous reconstructions were performed. Twenty-five patients underwent nonmandible osteocutaneous RFFF reconstruction. Eleven patients failed previous nonmicrovascular reconstruction. Reconstruction was for defects of the: palatomaxillary complex (n = 15), orbitomaxillary complex (n = 4), nasomaxillary complex (n = 4), larynx (n = 1), and clavicle (n = 1). There were no flap compromises. Postoperative complications included: 2 partial intraoral dehiscences; 1 recipient-site infection; and 1 seroma. Eight reconstructions required secondary procedures to improve functional and/or cosmetic outcomes. CONCLUSION: The osteocutaneous RFFF is a robust flap that can be used to reconstruct composite defects involving bone and soft-tissue beyond the mandible.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Qualidade de Vida , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Feminino , Antebraço/cirurgia , Retalhos de Tecido Biológico/classificação , Sobrevivência de Enxerto , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Hospitais Universitários , Humanos , Masculino , Mandíbula , Pessoa de Meia-Idade , Oregon , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Rádio (Anatomia)/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Análise de SobrevidaRESUMO
BACKGROUND: The osteocutaneous radial forearm free flap (OC-RFFF) remains a useful tool in head and neck reconstruction; however, it can be challenging to harvest sufficient bone for large reconstructions. The extended OC-RFFF is a modification that involves harvest of the distal border of the radius to the tip of the styloid. This increases the length of the bone flap by 2 cm to 3 cm, and the inherent contour of the styloid can be used to reconstruct the anterior curvature of the mandible or maxilla without additional osteotomies that may reduce blood supply. METHODS: The key steps in harvesting the extended OC-RFFF are described. Six patients with mandibular or maxillary defects underwent reconstruction with the extended OC-RFFF. Patient data including demographics, defect features, reconstruction details and outcomes were collected. RESULTS: Of the six patients who underwent the extended OC-RFFF, four had mandibular reconstruction and two had maxillary reconstruction. Two patients underwent reconstruction for osteoradionecrosis and the remainder for malignant disease. The average patient age at the time of surgery was 64.5 years. The length of radius harvested ranged from 8 cm to 14 cm (mean 9.7 cm). Two of six patients required a single osteotomy of their bone flap. Donor site complications included partial skin graft loss in 50% and a radius fracture in two patients. Recipient site complications included one patient with intraoral plate exposure. There have been no cases of nonunion. CONCLUSIONS: The extended OC-RFFF was a safe and reliable option for bony reconstruction in the head and neck.
HISTORIQUE: Le lambeau libre ostéocutané antébrachial radial (LL-OAR) étendu demeure utile pour la reconstruction de la tête et du cou. Cependant, il peut être difficile de prélever assez d'os pour effectuer des reconstructions importantes. Le LL-OAR étendu est une modification qui consiste à lever le bord distal du radius à la pointe de la styloïde. Cette technique accroît la longueur du lambeau osseux de 2 cm à 3 cm et permet d'utiliser le contour inhérent de la styloïde pour reconstruire la courbure antérieure de la mandibule ou de la maxillaire sans ostéotomies supplémentaires susceptibles de réduire l'apport sanguin. MÉTHODOLOGIE: Les auteurs ont décrit les principales étapes pour lever le LL-OAR étendu. Six patients présentant des anomalies mandibulaires ou maxillaires ont subi une reconstruction par LL-OAR étendu. Les auteurs ont décrit les données sur les patients, y compris les données démographiques, les caractéristiques des anomalies, les détails et les résultats de la reconstruction. RÉSULTATS: Des six patients qui ont reçu un LL-OAR étendu, quatre ont subi une reconstruction mandibulaire et deux, une reconstruction maxillaire. Dans deux cas, la reconstruction était causée par une ostéoradionécrose et dans les autres, par un cancer. Les patients avaient un âge moyen de 64,5 ans au moment de l'opération. Le radius prélevé était d'une longueur de 8 cm à 14 cm (moyenne de 9,7 cm). Deux des six patients ont dû subir une seule ostéotomie de lambeau osseux. Les complications au foyer du donneur incluaient une perte partielle de la greffe cutanée dans 50 % des cas et une fracture du radius chez deux patients. Les complications au foyer du receveur incluaient un patient dont la plaque intra-orale avait été exposée. Il n'y a eu aucun cas de non-union. CONCLUSIONS: Le LL-OAR étendu était sécuritaire et fiable pour procéder à la reconstruction osseuse de la tête et du cou.
RESUMO
BACKGROUND: The purpose of this study was to assess the impact of bone harvest length and multiple osteotomies on osteocutaneous radial forearm free flap (RFFF) complication rates. METHODS: A retrospective chart review was conducted for patients undergoing osteocutaneous RFFF reconstruction during an 8-year period. RESULTS: One hundred fifty-five osteocutaneous RFFF procedures were performed. Recipient-site flap complications were 18 of 55 (32.7%) when bone harvest length was less than 7 cm and 40 of 100 (40.0%) when it was ≥7 cm. No osteotomies were performed in 69 of 155 cases with a corresponding complication rate of 30.4% (21 of 69). One osteotomy was utilized in 69 of 155 flaps, whereas 17 of 155 required more than 1 osteotomy; complications were experienced in 42% (29 of 69) and 47% (8 of 17) of these cases, respectively. CONCLUSION: Osteocutaneous RFFF complication rates were only slightly higher when the bone length was ≥7 cm or when multiple osteotomies were required.