[Clinical comparison between radial and lateral forearm flap]

Case report: Immediate thumb reconstruction using reverse radial flap surgical technique

INTRODUCTION

The human hand is highly mobile and functional, being essential in the prehensile function. Thumb injuries are divided into distal, medial and proximal. Post-traumatic defects in the thumb can lead significant functional impairment. Reconstructive is always de primary goal to preserve function without pain.

CASE PRESENTATION

The case of a 37-years-old male, right hander, with a traumatic avulsion of the thumb in the right hand. On physical examination, exposure of the tendon and bone with distancing from the metacarpophalangeal joint, mobility function and Allen's clinical test of the palmar arch was preserved. We plan a reverse radial flap for coverage.

CLINICAL DISCUSSION

The anatomy of the hand represents a scope in working life and recreative activities. Surgical techniques are the primary tool in the management of reconstruction, being designed with the intention of maintaining integrity and optimal function. Flaps are a fundamental pillar in reconstructive practice.

CONCLUSION

The reverse radial forearm flap provides benefits among the reconstructive methods for soft tissues of coverage dorsal or palmar area of the hand in the scenario where the thumb suffers from slack and tissue is not available for reimplantation and when microsurgical options are not viable.

Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery. Report of six consecutive cases

Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.

Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function

There is controversy in the literature regarding donor site morbidity following radial forearm flap harvesting. The aim of this study was to verify possible functional and aesthetic impairments at the donor site. Thirty-five patients who underwent maxillofacial reconstruction using radial forearm flap were asked to give their subjective assessment of the aesthetic outcome at the donor site and of postoperative hand function. They were also examined for trophic status; cold intolerance and tactile sensitivity of split-thickness skin graft, palm and finger pads; grip strength and finger-to-thumb pinch strength; range of movement for the wrist and finger joints; as well as functional hand testing. Slight impairments regarding hand strength and mobility were observed. However, due to their small extent they were of no clinical relevance, as shown by 85.7% of our patients displaying optimal functional hand testing values (80-100%), and 88.6% giving a positive subjective assessment (80-100%) of postoperative vs preoperative hand function. The results show that donor site morbidity following radial forearm flap harvesting is low.