A 31-year review of composite radial forearm free flaps for head and neck reconstruction.

The aim of this study was to report the patient characteristics and radial fracture rates in a consecutive series of composite radial forearm free flap (CRFFF) for head and neck reconstruction over a 31-year period. The patients were identified from between 1990 to 2020 inclusive from theatre records and records from previous analyses at the Unit on free flap outcomes. Electronic case notes were accessed where available, to gather information on the operation, histopathology, and radiographs. Patients were categorised into three groups for analysis: (1) new oral cancers with a composite radial being the first choice of flap, (2) new oral cancers with a composite radial being the choice of flap following compromise of another bony flap, (3) osteoradionecrosis (ORN) cases. There were 103 CRFFF cases, median (IQR) age 69 (59-80) years, comprising 78 (Group 1), 5 (Group 2) and 20 (Group 3). The CRFFF failure rate was 6% (6/103) and the radius fracture rate was also 6% (6/103), both with 95% confidence interval 2.2-12.2%. Of the 6 radius fractures, 1 underwent surgical management (rush nailing), 1 died in hospital and the others managed with cast immobilisation. Two-year overall survival after surgery for the103 patients was 54% (SE 5%), while 5-year survival was 40% (SE 5%). In conclusion, in spite of the familiarity with other bone flaps such as fibular free flap, DCIA, scapula, and the limited bone stock and potential fracture related morbidity associated with the CRFFF, this flap still has a place in the surgical reconstructive armamentarium.

Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap.

The standard of care for head and neck reconstruction is microvascular free-tissue transfer. Various techniques of soft tissue, free-flap design have previously been described. Patient-specific planning and 3D printing have changed practice in bony reconstruction, but are not currently used in soft tissue head and neck reconstruction. We present the first report of Personalised pAtient-specific plaNning of SOFt tissue recOnStruction, the "PANSOFOS" flap, and aim to prove that the technique has a place in soft tissue reconstruction of the head and neck. Using the IDEAL framework for the reporting of surgical innovations (IDEAL stage 1, proof of concept report), we describe the case of a patient with oral cancer who had reconstruction of the tongue after hemiglossectomy. The staging scans, 3D printer and software were used to create a soft silicon resection guide and flap harvesting guide. The 3D guide was then used to design a 2D outline of the perimeter of the flap, and a negative silicone mould used to control its bulk. The procedure was successful and the postoperative period uneventful. The oncological, cosmetic, and functional outcomes were excellent. The patient followed the local enhanced recovery pathway and was discharged home with safe swallowing. This report confirms that patient-specific 3D planning can be used in the reconstruction of soft tissue defects of the head and neck. We aim to develop the technique using the next stages of the IDEAL framework, and anticipate that the PANSOFOS flap will become a standard of care.