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Al-Aroomi MA, Duan W, Al-Worafi NA, Al-Moraissi EA, Mashrah MA, Liu M, Xue X, Sun C. Radial and Ulnar Forearm Free Flaps: A Critical Comparison of Donor-Site Morbidity and Its Impact on Quality of Life. Plast Reconstr Surg 2024; 154:650-661. [PMID: 37621015 DOI: 10.1097/prs.0000000000011022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND A poor evidence basis exists regarding directly comparing objective and subjective donor-site morbidity associated with the forearm flap. The authors evaluated the postoperative donor-site complications and quality-of-life outcomes between the radial forearm free flap (RFFF) and the ulnar forearm free flap (UFFF). METHODS All patients undergoing RFFF or UFFF harvest were included. Grip strength, pinch strength, wrist range of movement, and testing of skin sensitivity were assessed with the appropriate scales at different time intervals. In addition, appearance and quality of life were assessed using the Patient and Observer Scar Assessment Scale and the Disabilities of Arm, Shoulder, and Hand instruments. RESULTS Eighty patients were enrolled (RFFF, n = 40; and UFFF, n = 40). A short-term reduction in grip strength, fine motor skills (tip pinch, key pinch, palmar pinch), and range of motion was observed for the RFFF group and improved over time. None of the patients in either group experienced functional disturbance in grip strength, wrist motion, fine motor skills, or sensation to light touch at 1 year. Nine patients experienced partial skin graft loss (RFFF, n = 6; UFFF, n = 3). There was a significantly higher incidence of temporary numbness in the RFFF group ( P = 0.040). Persistent numbness occurred in 3 cases in the RFFF group. Cold intolerance was significantly lower in the UFFF group (2.5%) than in RFFF group (22.5%). Moreover, the mean Patient and Observer Scar Assessment Scale and Disabilities of Arm, Shoulder, and Hand scores were reduced at 12 months compared with 6 months, significantly superior for UFFF. CONCLUSIONS Objective function limitations are reversible short-term effects after forearm flap and do not affect daily routines in the long term. In addition, UFFF appears to be preferred over RFFF for subjective outcomes, which emphasizes that UFFF should be considered as an alternative to RFFF for reconstructing soft-tissue defects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Weiyi Duan
- From the Departments of Oral and Maxillofacial Surgery
| | | | | | - Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University
| | - Minda Liu
- From the Departments of Oral and Maxillofacial Surgery
| | - Xiaomeng Xue
- From the Departments of Oral and Maxillofacial Surgery
| | - Changfu Sun
- From the Departments of Oral and Maxillofacial Surgery
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Suda S, Hayashida K. Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction. Life (Basel) 2024; 14:223. [PMID: 38398732 PMCID: PMC10890180 DOI: 10.3390/life14020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.
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Affiliation(s)
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan;
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Microsurgical Techniques and Postoperative Outcomes After Total and Subtotal Nasal Reconstruction: A Systematic Review. Ann Plast Surg 2021; 88:679-686. [PMID: 34864749 DOI: 10.1097/sap.0000000000003032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple microsurgical techniques for nasal reconstruction have been described in the literature. Given the gaps in the literature regarding evidence-based reviews for total and subtotal nasal reconstruction using microsurgical techniques, the purpose of this study was to provide a thorough presentation of the most popular microvascular techniques and their outcomes (functional and aesthetic) for total or subtotal nasal defects. METHODS A systematic search was performed using PubMed, Google Scholar, and Cochrane Library on free flap techniques for restoration of nasectomy defects. The keywords were "nasal reconstruction," "nose," "nasectomy," "rhinectomy," and "microvascular." Inclusion criteria for analysis in the study were the largest clinical case series published in English within the past 15 years with more than 8 patients.Studies were analyzed for patient demographics, etiology of nasal loss, surgical approaches to reconstruction, outcomes, and complications. The current study was registered at the International Prospective Register of Systematic Reviews and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS The initial search yielded 302 results. Eleven articles with a total of 232 patients met the inclusion criteria. The radial (n = 85) and ulnar forearm flaps (n = 20), auricular helical rim (n = 87), and anterolateral thigh flap (n = 30) were the most commonly reported free flaps in nasal reconstruction. The main etiologic factors were malignancy and trauma. The most common complication was partial flap necrosis. CONCLUSIONS The auricular helical and radial forearm flaps represent the most used free flaps for total and/or subtotal nasal defects with satisfactory patient outcomes.
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Guiotto M, di Summa PG, Argentino G, Cherubino M. The proximal ulnar perforator flap (PUPF) for hand digital reconstruction: an anatomical study. J Plast Surg Hand Surg 2021; 55:255-259. [PMID: 33487080 DOI: 10.1080/2000656x.2021.1873793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Degloving injuries of the fingers represent a reconstructive challenge. Even if poorly described in literature, the proximal ulnar perforator flap (PUPF), based on perforator of the anterior ulnar recurrent artery or directly on a perforator branch of the ulnar artery, meets the requested criteria for the ideal coverage. We performed a cadaveric study in order to clarify the anatomical basis and vascularization of the PUPF flap. Eight injected upper limb specimens were dissected for this study: perforators were followed down to their origin and classified in terms of number, length, diameters and distances between their emergence and specific pre-determined landmarks as the medial humeral epicondyle. At least one ulnar perforator in the proximal third of the forearm was identified in all the specimens. In 50% of the upper limbs, the perforator branch came directly from the ulnar artery, while in the 87.5% a perforator branch came from the anterior recurrent ulnar artery; in 3 out of 8 cases both perforator branches were described. Mean lengths of the perforator branch were 57.9 mm and 44.3 mm, respectively and the mean diameters measured at their origin were 0.99 mm and 1.17 mm respectively. Our data illustrate the consistency of at least one perforator branch from the proximal third of the ulnar artery, most commonly coming from the anterior recurrent ulnar artery. Considering our results, the PUPF could be a good alternative to the classical free flaps for the resurfacing of the finger defects.
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Affiliation(s)
- Martino Guiotto
- Department of Plastic Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pietro Giovanni di Summa
- Department of Plastic Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Giulia Argentino
- Department of Plastic, Reconstructive and Hand Surgery, University of Catania, Catania, Italy
| | - Mario Cherubino
- Plastic surgery Unit, Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy
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de Vicente JC, Espinosa C, Rúa-Gonzálvez L, Rodríguez-Santamarta T, Alonso M. Hand perfusion following radial or ulnar forearm free flap harvest for oral cavity reconstruction: A prospective study. Int J Oral Maxillofac Surg 2020; 49:1402-1407. [PMID: 32402690 DOI: 10.1016/j.ijom.2020.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022]
Abstract
The radial forearm free flap (RFFF) and ulnar forearm free flap (UFFF) are used in head and neck reconstruction because they provide a thin and pliable skin paddle as well as a long vascular pedicle. However, in spite of several studies showing the safety of the UFFF, the RFFF is more popular among reconstructive surgeons based on concerns about hand ischaemia. A prospective study was designed in which 10 UFFF and 11 RFFF surgeries were performed in 20 patients undergoing oral cavity reconstruction between January 2017 and July 2018. Hand vascular parameters were evaluated preoperatively and postoperatively using Doppler ultrasound and plethysmography. The preoperative and postoperative diameters of the radial and ulnar arteries, and the flow velocities through the remainder of the forearm artery were measured preoperatively and at 3 months postoperative. Additionally, a comparison was performed between the preoperative and postoperative fingertip perfusion values according to impedance plethysmography. The preoperative mean diameter of the radial artery (2.89±0.47mm) was significantly greater than that of the ulnar artery (2.35±0.48mm) at the level of the wrist; however, 3 months after the surgery, the mean diameters of the two arteries did not differ significantly. There were no differences in digital perfusion when a UFFF was used compared with an RFFF.
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Affiliation(s)
- J C de Vicente
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, University of Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Asturias, Spain.
| | - C Espinosa
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, University of Oviedo, Asturias, Spain
| | - L Rúa-Gonzálvez
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, University of Oviedo, Asturias, Spain
| | - T Rodríguez-Santamarta
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, University of Oviedo, Asturias, Spain
| | - M Alonso
- Department of Vascular Surgery, Hospital Universitario Central de Asturias, Asturias, Spain
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Chang EI, Liu J. Prospective Comparison of Donor-Site Morbidity following Radial Forearm and Ulnar Artery Perforator Flap Harvest. Plast Reconstr Surg 2020; 145:1267-1274. [PMID: 32332551 DOI: 10.1097/prs.0000000000006790] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap. METHODS All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. RESULTS A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Edward I Chang
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
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Wang S, Yin S, Zhang ZL, Su X, Xu ZF. Quality of Life After Oral Cancer Resection and Free Flap Reconstruction. J Oral Maxillofac Surg 2019; 77:1724-1732. [DOI: 10.1016/j.joms.2019.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/24/2022]
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Bertino G, Lepenne Y, Tinelli C, Giordano L, Cacciola S, Di Santo D, Occhini A, Benazzo M, Bussi M. Radial vs ulnar forearm flap: a preliminary study of donor site morbidity. ACTA ACUST UNITED AC 2019; 39:322-328. [PMID: 30933177 PMCID: PMC6843587 DOI: 10.14639/0392-100x-2102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/02/2018] [Indexed: 12/03/2022]
Abstract
The objective of this study was to compare donor site morbidity after reconstructive surgery with Ulnar Forearm Free Flap (UFFF) and Radial Forearm Free Flap (RFFF) with subjective methods. The UFFF and the RFFF were applied for reconstruction of soft tissue defects of the head and neck region in 30 patients (20 M and 10 F; age range 28-75 years) affected by head and neck squamous cell carcinoma. The Disability of Arm, Shoulder and Hand (DASH) questionnaire was used to assess morbidity of the donor site. Analysis of the patients’ DASH scores showed an overall median DASH total score of 9.17. No significant differences were observed for median values of the RFFF and UFFF groups (7.14 vs 10 respectively) or for the values in males and females (5 vs 13.3 respectively). The UFFF can be considered a valid alternative to the RFFF for reconstruction of soft tissue defects of the head and neck area; it is safe, easy to harvest and is not associated with major morbidities of the donor site as demonstrated by the DASH questionnaire.
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Affiliation(s)
- G Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Y Lepenne
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Tinelli
- Biometric Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - L Giordano
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - S Cacciola
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - D Di Santo
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - A Occhini
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Benazzo
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Bussi
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
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Appraisal of the Free Ulnar Flap Versatility in Craniofacial Soft-tissue Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1863. [PMID: 30349774 PMCID: PMC6191208 DOI: 10.1097/gox.0000000000001863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022]
Abstract
The unique anatomical characteristics of the forearm region make it especially popular as a free flap donor site for craniofacial soft-tissue reconstruction. The free ulnar forearm flap is less hirsute and allows for better concealment of donor site scar as compared with its radial counterpart. Despite these factors, the free radial forearm flap remains more popular among reconstructive surgeons. Through the presented case series, we hope to emphasize the versatile nature of the free ulnar forearm flap in addressing various craniofacial soft-tissue defects. Following institutional review board approval, a retrospective review of the senior authors' clinical experience performing microvascular free ulnar forearm flap reconstruction of craniofacial soft-tissue defects was performed. A total of 10 patients were identified through our review. Soft-tissue defect locations included lower eyelid (n = 2), tongue and floor of mouth (n = 2), lower lip (n = 2), palatopharyngeal area (n = 1), nose (n = 1), and palate (n = 1). Trauma was the most common defect etiology (n = 5), followed by malignancy (n = 4), and iatrogenic injury in 1 case. All patients demonstrated good aesthetic and functional outcomes related to vision, speech, and oral intake at follow-up when applicable. The free ulnar forearm flap is a versatile reconstructive option that can be used to address a wide spectrum of craniofacial soft-tissue defects and offers numerous advantages over its radial counterpart.
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Cherubino M, Corno M, Valdatta L, Adani R. Thumb Reconstruction With Thin Proximal Ulnar Perforator Free Flap. J Hand Surg Am 2017; 42:e133-e138. [PMID: 28160906 DOI: 10.1016/j.jhsa.2016.11.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/01/2016] [Accepted: 11/15/2016] [Indexed: 02/02/2023]
Abstract
Soft tissue defects of the thumb with exposure of tendons, periosteum, or neurovascular bundles require a complex reconstruction aimed at restoring both skin coverage and the essential function of pinching and manipulation. When large defects are involved, a free tissue transfer is indicated. The proximal ulnar perforator flap represents an interesting solution without the drawbacks of other more widespread free flaps. This report describes the case of a patient with a squamous cell carcinoma of the thumb that required circumferential resection of the soft tissue of the distal phalanx and the interphalangeal joint. The exposed structures were covered with pliable and texture-matching skin harvested from the proximal volar forearm and based on the proximal ulnar perforator. After 12-month follow-up, the patient was satisfied with the aesthetic outcome. Donor-site morbidity was minimal and no functional impairment in daily-life activities was reported. Even though a skilled microsurgical technique is required for the dissection of the perforator, its constant vascular anatomy and the low risk of damage to the main neurovascular bundle should make this flap reliable for the majority of hand surgeons.
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Affiliation(s)
- Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Martina Corno
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Roberto Adani
- Department of Hand and Microsurgery, University Hospital of Modena, Modena, Italy
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Huang AT, Day TA. Double paddle ulnar perforator free flap in reconstruction of through-and-through and fistulous defects of the head and neck. Laryngoscope 2016; 127:1302-1305. [PMID: 28000215 DOI: 10.1002/lary.26440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/28/2016] [Accepted: 11/02/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Roy J, Henry BM, PĘkala PA, Vikse J, Saganiak K, Walocha JA, Tomaszewski KA. Median and ulnar nerve anastomoses in the upper limb: A meta-analysis. Muscle Nerve 2016; 54:36-47. [DOI: 10.1002/mus.24993] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/14/2015] [Accepted: 11/20/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Joyeeta Roy
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
- International Evidence-Based Anatomy Working Group; Krakow Poland
| | - Brandon M. Henry
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
- International Evidence-Based Anatomy Working Group; Krakow Poland
| | - PrzemysŁaw A. PĘkala
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
- International Evidence-Based Anatomy Working Group; Krakow Poland
| | - Jens Vikse
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
- International Evidence-Based Anatomy Working Group; Krakow Poland
| | - Karolina Saganiak
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
| | - Jerzy A. Walocha
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
- International Evidence-Based Anatomy Working Group; Krakow Poland
| | - Krzysztof A. Tomaszewski
- Department of Anatomy; Jagiellonian University Medical College; 12 Kopernika Street 31-034 Krakow Poland
- International Evidence-Based Anatomy Working Group; Krakow Poland
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Median antebrachial vein for drainage of the ulnar free forearm flap. Br J Oral Maxillofac Surg 2014; 52:864-5. [PMID: 25091635 DOI: 10.1016/j.bjoms.2014.07.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/14/2014] [Indexed: 11/23/2022]
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