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Farlow JL, McCrary HC, Meeker M, Alexander J, Haring CT, Old MO, Kang SY, Rohde SL, Seim NB. The osteocutaneous radial forearm free flap: A multidisciplinary review of the evidence. Oral Oncol 2024; 157:106925. [PMID: 39024698 DOI: 10.1016/j.oraloncology.2024.106925] [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: 02/25/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
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.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Hilary C McCrary
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Molly Meeker
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John Alexander
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Sarah L Rohde
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nolan B Seim
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.
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2
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Russell J, Breik O, Borgna SC, Volker G, Pateman K, Batstone M. Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series. Int J Oral Maxillofac Surg 2024; 53:275-281. [PMID: 37858382 DOI: 10.1016/j.ijom.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores.
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Affiliation(s)
- J Russell
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - O Breik
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S C Borgna
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - G Volker
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - K Pateman
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - M Batstone
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Hurley CM, McConn Walsh R, Shine NP, O'Neill JP, Martin F, O'Sullivan JB. Current trends in craniofacial reconstruction. Surgeon 2022; 21:e118-e125. [PMID: 35525818 DOI: 10.1016/j.surge.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/23/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
Reconstruction of the head and neck continues to pose a variety of difficult functional and aesthetic challenges to the plastic surgeon. While the surgical treatment for midfacial and skull base tumours continues to advance, the three-dimensional reconstruction predicaments continue to increase in complexity. Reconstructive strategies of the head and neck require the restoration of intricate skeletal architecture and large volumes of both internal and external soft tissue envelopes that can withstand adjuvant therapies. Vascularized bone grafts in combination with microsurgical techniques is the current trend of most reconstruction and has replaced local and pedicle flaps as the preferred modality for large defects. This article will focus on concise areas of difficulty in craniofacial reconstruction, including mandibular, midfacial, scalp and base of skull reconstruction. As our goals now move from flap survival to refinement, more complex and innovative reconstructions are executed. The problems with each modality are examined, and the frontiers of head and neck reconstruction are explored. With the potential combination of virtual surgery and tissue engineered biotechnology, we may someday be able to expand our reconstructive capabilities beyond free tissue transfer.
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Affiliation(s)
- C M Hurley
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland.
| | - R McConn Walsh
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - N P Shine
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - J P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - F Martin
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - J B O'Sullivan
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
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Karadaghy OA, Mussatto CC, Schatz BA, Li J, Norris TW, Nallani R, Shnayder L, Kakarala K, Tsue TT, Girod DA, Li Y, Koestler DC, Villwock MR, Harn N, Bur AM. Rates of bone reabsorption and union in mandibular reconstruction using the osteocutaneous radial forearm free flap. Head Neck 2022; 44:420-430. [PMID: 34816528 DOI: 10.1002/hed.26939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Omar A Karadaghy
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Benjamin A Schatz
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer Li
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taylor W Norris
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Rohit Nallani
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lisa Shnayder
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Terance T Tsue
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Douglas A Girod
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yanming Li
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Devin C Koestler
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nick Harn
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M Bur
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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5
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O'Connell JE, Koumoullis H, Lowe D, Rogers SN. A 31-year Review of Composite Radial Forearm Free Flaps for Head and Neck Reconstruction. Br J Oral Maxillofac Surg 2022; 60:915-921. [DOI: 10.1016/j.bjoms.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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Butterworth CJ, Lowe D, Rogers SN. The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low-level maxillary malignancy - clinical & patient related outcomes on 35 consecutively treated patients. Head Neck 2021; 44:345-358. [PMID: 34825746 DOI: 10.1002/hed.26933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The zygomatic implant perforated (ZIP) flap technique provides immediate reconstruction and rapid dental rehabilitation for low-level malignant tumors. METHODS Patients who underwent ZIP flap reconstruction between December 2015 and February 2021 were followed prospectively. RESULTS Thirty-five consecutively treated patients were studied with 16 undergoing surgery alone and 19 undergoing surgery followed by radiotherapy. The median time to fit the prosthesis was 29 days with all patients requiring adjuvant radiotherapy receiving their fixed dental prosthesis prior to its commencement. Vascularized flap (100%), zygomatic implant (98.4%), and prosthesis (97%) survival were excellent and the ZIP flap protocol was highly rated by patient-related outcome measures especially for the chewing domain. CONCLUSIONS The ZIP flap technique provides an excellent means of providing an autogenous oronasal seal and a foundation for immediate cortically anchored fixed dental rehabilitation. CLINICAL SIGNIFICANCE This technique provides rapid and robust rehabilitation for patients presenting with low-level maxillary malignancy despite the use of radiotherapy.
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Affiliation(s)
- Chris J Butterworth
- Department of Oral and Maxillofacial Surgery, Liverpool University Hospital Foundation Trust, Liverpool, UK.,Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Simon N Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.,Liverpool University Hospital Foundation Trust, Liverpool, UK
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7
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Le JM, Morlandt AB, Gigliotti J, Park EP, Greene BJ, Ying YP. Complications in oncologic mandible reconstruction: A comparative study between the osteocutaneous radial forearm and fibula free flap. Microsurgery 2021; 42:150-159. [PMID: 34792210 DOI: 10.1002/micr.30841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The osteocutaneous radial forearm free flap (OC-RFFF) has been proposed as a safe and reliable free flap for head and neck reconstruction with low donor site morbidity. The purpose of this study is to compare the late complications (>30 days) associated with using the OC-RFFF versus the free fibula flap (FFF) for mandibular reconstruction following oncologic segmental resection. METHODS We conducted a single-institution, retrospective study composed of patients who underwent oncologic microvascular composite mandibular reconstruction with either the OC-RFFF or FFF. The primary predictor variable was the type of free flap used. The outcome variable was late complication postoperatively (>30 days). RESULTS A total of 93 patients (28, OC-RFFF and 65, FFF) were analyzed. The majority of patients were male (62%) and with AJCC stage T4a disease (72%). Mean hospital length of stay was comparable between the two flap groups (p = .50). OC-RFFF was associated with more late complications (p = .03) compared to FFF. Nonunion occurred in 10.7% of OC-RFFF and 0% of FFF. Partial or complete flap failure was seen in 7.1% and 0% in the OC-RFFF and FFF, respectively. Two-year disease-free survival was comparable in both groups (p > .05). CONCLUSIONS The results of this study suggest that the rate of nonunion and odds of having a late complication were significantly greater in the OC-RFFF compared to the FFF following oncologic mandibular reconstruction. However, flap success, early complications (<30 days), and length of hospital stay were comparable between the two flaps.
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Affiliation(s)
- John M Le
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anthony B Morlandt
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan Gigliotti
- Department of Oral and Maxillofacial Surgery, McGill University, Montreal, Quebec, Canada
| | - Earl P Park
- Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Benjamin J Greene
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yedeh P Ying
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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8
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Miller H, Bush K, Delancy M, Leo ND, Joshi H, Saracco B, Adams A, Gaughan J, Bonawitz S. Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: An updated systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 75:743-752. [PMID: 34810143 DOI: 10.1016/j.bjps.2021.09.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is an ongoing debate about whether neoadjuvant radiation therapy is associated with higher rates of postoperative complications after head and neck reconstruction. Herle et al. conducted a systematic review in 2014 of 24 studies, finding higher complication rates in irradiated fields. We sought to perform an exhaustive updated systematic review and meta-analysis. METHODS We conducted an updated systematic review of the literature, as outlined in our protocol, which was registered on PROSPERO. Databases included Medline, Embase, Cochrane Central, and Web of Science. There were no limits placed on the date range, place of publication, or origin. Exclusion criteria included patients less than 18 years of age, studies with less than 20 participants (n < 20), case studies, skull base reconstructions, and local tissue rearrangements. The combined results of the studies and relative risks (RR) were calculated. RESULTS 53 studies were included for analysis, including 5,086 free flaps in an irradiated field, and 9,110 free flaps in a non-irradiated field. Of the 53 studies, 21 studies overlapped with those discussed in Herle et al.'s study, with a total of 32 additional studies. Neoadjuvant radiation was found to be a statistically significant risk factor for postoperative complications (RR 1.579, P < 0.001), total flap failure (RR, 1.565; P < 0.001), and fistula (RR, 1.810; P < 0.001). Our work reaffirmed the findings of the Herle et al. STUDY CONCLUSION Preoperative radiation was associated with a statistically significant increase in the risk of total flap failure, fistula, and total complications but not partial flap failure. These high-morbidity complications must be taken into consideration when determining which patients should receive neoadjuvant radiation therapy.
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Affiliation(s)
- Henry Miller
- Department of Surgery, Cooper University Hospital, Camden NJ, United States.
| | - Kathryn Bush
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Matthew Delancy
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Nicholas De Leo
- Department of Surgery, Cooper University Hospital, Camden NJ, United States
| | - Hansa Joshi
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Benjamin Saracco
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Amanda Adams
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - John Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden NJ, United States
| | - Steven Bonawitz
- Department of Surgery, Cooper University Hospital, Camden NJ, United States
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Prevention and Management of Complications of Tissue Flaps. Surg Clin North Am 2021; 101:813-829. [PMID: 34537145 DOI: 10.1016/j.suc.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this article, we discuss 4 common free flaps performed in reconstructive surgery: the anterolateral thigh flap, the radial forearm flap, the fibula flap, and the transverse rectus abdominis myocutaneous/deep inferior epigastric perforator flap. Donor and recipient complications for each flap type and strategies on how to prevent and manage such complications are discussed.
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10
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Systematic Review of Clinical Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Nasal Prostheses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073756. [PMID: 33916853 PMCID: PMC8038514 DOI: 10.3390/ijerph18073756] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022]
Abstract
The aim of this systematic review was to gather the clinical and laboratory applications of CAD/CAM technology for preoperative planning, designing of an attachment system, and manufacturing of nasal prostheses. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was carried out. Only human clinical studies involving digital planning for the rehabilitation of facial defects were included. A total of 21 studies were included with 23 patients, which were virtually planned through different planning software. The most common preoperative data for digital planning were CT scans in nine cases, CBCT in six cases, and laser scans in six cases. The reported planning softwares were Mimics in six cases, Geomagic Studio software in six cases, ZBrush in four cases, and Freeform plus software in four cases. Ten surgical templates were designed and printed to place 36 implants after digital planning, while post-operative assessment was done in two cases to check the accuracy of planned implants. Digital 3D planning software was reported for presurgical planning and craniofacial implants placement, fabrication of molds, designing of implants, designing of retentive attachments, and printing of silicone prostheses. Digital technology has been claimed to reduce the clinical and laboratory time; however, the equipment cost is still one of the limitations.
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Russell J, Pateman K, Batstone M. Donor site morbidity of composite free flaps in head and neck surgery: a systematic review of the prospective literature. Int J Oral Maxillofac Surg 2021; 50:1147-1155. [PMID: 33531270 DOI: 10.1016/j.ijom.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
Composite free flaps represent the cornerstone for the repair of osseous defects in the head and neck. For many patients, there are often multiple defect-suitable donor sites that may be utilised as part of the reconstructive process. Therefore, to optimise patient outcomes, an evidence-based approach to donor site selection is required to maximise quality of life and long-term functionality. A systematic review of the literature was conducted in accordance with PRISMA guidelines to evaluate the evidence for donor site selection based on minimising the associated donor site morbidity and optimising patient functionality postoperative. The fibula is associated with the greatest potential risk for wound healing complications. Fibula and scapula harvest has the potential to have a significant impact on physical performance. The iliac crest is most favourable in terms of aesthetic scar healing outcomes. Overall, however, the quality and quantity of evidence for all donor sites is limited. Each site is associated with specific complications and morbidity, of which the surgeon and patient must both be aware. Whilst a cross-sectional informed opinion of the likely advantages/disadvantages of one donor site over another can thus be made, there are few head-to-head studies available that directly compare donor sites.
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Affiliation(s)
- J Russell
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - K Pateman
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - M Batstone
- Maxillofacial Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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12
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Mashrah MA, Aldhohrah TA, Abdelrehem Moustafa A, Al-Sharani HM, Alrmali A, Wang L. Are hand biomechanics affected following radial forearm flap harvest? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 50:21-31. [PMID: 32665139 DOI: 10.1016/j.ijom.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022]
Abstract
Donor site morbidity following radial forearm flap (RFF) harvest remains a controversial issue. The aim of this meta-analysis was to answer the question "Are the range of wrist movements (range of motion, ROM) and hand strength affected after RFF harvesting?" The PubMed, Embase, Scopus, and Cochrane Library electronic databases were systematically searched (to December 2019). Self-controlled studies evaluating hand biomechanics after RFF harvest were included. Weighted mean differences with 95% confidence intervals were calculated using the random-effects model. The outcome variables were ROM, forearm movements, grip, and pinch strengths. Thirteen studies involving a total of 335 patients were included. With the exception of grip strength and supination, which showed statistically significant reductions of about 2.40 kg and 2.86° (P < 0.05), all other ROM, forearm movements, and pinch strengths showed an insignificant difference when the operated hand was compared to the non-operated hand (P > 0.05). Regression analysis showed that the method of donor site closure and size of the donor site defect had an insignificant impact on hand biomechanics. This study confirms the lack of discernible biomechanical morbidity after RFF transfer. The minimal reduction in hand biomechanics after RFF is considered to be clinically negligible.
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Affiliation(s)
- M A Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China.
| | - T A Aldhohrah
- Guanghua Stomatology Hospital, Sun Yat-Sen University, Guangdong, Guangzhou, China
| | - A Abdelrehem Moustafa
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - A Alrmali
- Faculty of Dentistry, Tripoli University, Tripoli, Libya
| | - L Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China.
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Abstract
Reconstruction of the complex anatomy and aesthetics of the midface is often a challenge. A careful understanding of this three-dimensional (3D) structure is necessary. Anticipating the extent of excision and its planning following oncological resections is critical. In the past over two decades, with the advances in microsurgical procedures, contributions toward the reconstruction of this area have generated interest. Planning using digital imaging, 3D printed models, osseointegrated implants, and low-profile plates, has favorably impacted the outcome. However, there are still controversies in the management: to use single composite tissues versus multiple tissues; implants versus autografts; vascularized versus nonvascularized bone; prosthesis versus reconstruction. This article explores the present available options in maxillary reconstruction and outlines the approach in the management garnered from past publications and experiences.
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Affiliation(s)
- Gautam Biswas
- Department of Plastic and Reconstructive Surgery, TATA Medical Center, Kolkata, West Bengal, India
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14
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Tang MY, Luo DW, Sun LB, Zhou HY, Wu SJ, Fu GX, Xiao JG. [Application of a modified paramedian lower lip-submandibular approach in maxillary (subtotal) total resection]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:380-384. [PMID: 32865355 DOI: 10.7518/hxkq.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the clinical efficacy of a modified paramedian lower lip-submandibular approach for maxillary (subtotal) total resection. METHODS Eleven patients of maxillary tumors underwent maxillary (subtotal) total resection through the modified paramedian lower lip-submandibular approach. Clinical follow-up visits were conducted to evaluate appearance restoration, facial nerve functional status, parotid gland functional status, and orbital region complication. RESULTS During the follow-up period of 6-36 months, the appearance of all 11 patients recovered well. All cases presented hidden scars. No facial nerve and parotid duct injury, lower eyelid edema, lower eyelid ectropion, or epiphora in all cases was observed. CONCLUSIONS Applying modified paramedian lower lip-submandibular approach to maxillary (subtotal) total resection effectively reduces incidence of orbital region complications including lower eyelid edema, lower eyelid ectropion, and epiphora, which often occur to traditional approach. The modified approach produces more subtle scars than other methods and should be applied to treatment of maxillary (subtotal) total resection.
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Affiliation(s)
- Meng-Ying Tang
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China;Dept. of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Dao-Wen Luo
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Li-Bo Sun
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Hang-Yu Zhou
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Shuang-Jiang Wu
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Guang-Xin Fu
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Jin-Gang Xiao
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China;Dept. of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China;Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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Hendricks R, Patel Z, Pooran A, Vicatos G. Revascularized Fibula Free Flap Reconstruction and Curvilinear Transport Distraction Osteogenesis in Closure of Large Postmaxillectomy Defects: A New Gold Standard? Ann Maxillofac Surg 2020; 10:304-311. [PMID: 33708572 PMCID: PMC7943987 DOI: 10.4103/ams.ams_267_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: The revascularized fibula free flap (RFFF) is the most popular method of postmaxillectomy reconstruction. This article proves that the use of curvilinear transport distraction osteogenesis (CTDO) is an efficacious way in closing large defects in the maxilla and a superior alternative to the RFFF. Methods and Materials: In a prospective cohort study of six postmaxillectomy patients, CTDO was applied and the new bone (regenerate) was compared with the parent bone from which it had been regenerated. These results were compared with a retrospective group of six participants of similar age and sex who had undergone RFFF reconstruction as an external control. Clinical measurements taken at the depth of the alveolar vestibule were recorded at three different exact points juxtaposed, namely (A) lateral incisor, (B) first premolar, and (C) first molar. These areas of interest were similar to those chosen on the CT scans. Impressions were taken from all the patients and stone casts were made. The width of the alveolar bone was computed based on the measurements made from the stone casts. The stone casts were then used to calculate the width and depth of the soft tissue and bone in the maxilla in the (A), (B), and (C) regions. Results: The regenerate possessed anatomical and physiological characteristics equal to the parent bone. For the CTDO patients, prosthetic rehabilitation of the dentition was supported by dental implants after osseointegration of the latter into the newly created bone and soft tissue. Discussion: The production of the curvilinear bone and soft tissue along a horizontal plane has been demonstrated. The new alveolar bone achieved the correct width and depth to create a physiological vestibule and a functional/esthetic zone for the placement of dental implants. In addition, the shape of the palatal vault was also maintained. The CTDO method is a reliable method of maxillary reconstruction and has a better anatomical and functional outcome than the RFFF.
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Affiliation(s)
- Rushdi Hendricks
- Department of Plastic Reconstructive and Maxillofacial Surgery, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Zaheed Patel
- Department of Plastic Reconstructive and Maxillofacial Surgery, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Anil Pooran
- Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, Division of Pulmonology, Centre for Lung Infection and Immunity, University of Cape Town, South Africa
| | - George Vicatos
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, Cape Town, South Africa
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Subjective morbidity following radial free flap reconstruction in head and neck tumour patients. The Journal of Laryngology & Otology 2019; 133:230-235. [DOI: 10.1017/s0022215119000197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveEvaluation of post-operative donor site disability remains unaddressed in radial forearm free flap cases. This study aimed to assess donor site dysfunction following radial forearm free flap harvest using validated general, disease-specific and site-specific disability questionnaires.MethodsIn this retrospective case series of 24 patients at a tertiary academic medical centre, patients were assessed using the Short Form 36 Health Survey, Short Musculoskeletal Function Assessment questionnaire, and Disabilities of the Arm, Shoulder and Hand questionnaire. One-sample z-tests were performed, comparing means of the cohort to controls.ResultsCompared to population controls, the cohort had higher mean scores for the Disabilities of the Arm, Shoulder and Hand questionnaire (18.22 vs 10.1, p < 0.01), and Short Musculoskeletal Function Assessment questionnaire bothersome index (21.44 vs 13.77, p = 0.04), and a lower mean score for the Short Form 36 Health Survey physical component (38.88 vs 50, p < 0.01), indicating a greater disability for the cohort compared to controls.ConclusionRadial forearm free flap harvest causes significant long-term donor site disability in head and neck tumour patients. The Disabilities of the Arm, Shoulder and Hand questionnaire is a concise tool for measuring this dysfunction.
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Comparison of the hospitalization period after microvascular reconstruction flap in trismus patients: free anterolateral thigh flap versus free forearm flap. Clin Oral Investig 2019; 23:2951-2957. [PMID: 30617585 DOI: 10.1007/s00784-018-02799-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/20/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The primary strategy for treating oral squamous cell carcinoma (OSCC) is therapeutic resection, with the trismus resection defect reconstructed via free flap. The most popular free flaps include the radial forearm free flap (RFFF) and anterolateral thigh free flap (ALT). This study investigated the relationships between the hospitalization period and a variety of surgical outcomes, as well as maximum inter-incisor distance (IID), in trismus patients who chewed betel nuts. MATERIALS AND METHODS Forty-nine primary OSCC patients who chewed betel nuts and underwent surgical resection and reconstruction between 2010 and 2016 were enrolled in this retrospective study. The data were from a single center in Taiwan. The outcome variable after flap recovery surgery was the duration of postoperative hospitalization. Other factors that were analyzed comprised correlations between hospitalization and a variety of factors, including postoperative inter-incisor distances (IIDs), operative time, gender, and WBC count, upon stratification into two reconstruction groups. RESULTS The mean postoperative hospitalization duration in the ALT group was 22.9 ± 7.2 days, which was significantly shorter than that in the RFFF group (27.8 ± 7.0 days; p = 0.019). Two-week postoperative IID (ALT group: 16.1 ± 0.8 mm; RFFF group: 7.0 ± 0.6 mm) was inversely related to the duration of hospitalization (p = 0.022, r = - 0.372). CONCLUSIONS The ALT flap is more effective than the RFFF flap to reduce the length of hospitalization in trismus patients. CLINICAL RELEVANCE The ALT flap should be considered as a first-line technique in OSCC reconstruction in trismus patient reconstruction.
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Pabst A, Werkmeister R, Steegmann J, Hölzle F, Bartella A. Is there an ideal way to close the donor site of radial forearm free flaps? Br J Oral Maxillofac Surg 2018; 56:444-452. [DOI: 10.1016/j.bjoms.2018.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/15/2018] [Indexed: 10/16/2022]
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