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The radial forearm free flap as a “vascular bridge” for secondary microsurgical head and neck reconstruction in a vessel‐depleted neck
Author(s) -
Ciudad Pedro,
Agko Mouchammed,
Date Shivprasad,
Chang WeiLing,
Manrique Oscar J.,
Huang Tony C. T.,
Lo Torto Federico,
Trignano Emilio,
Chen HungChi
Publication year - 2018
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30259
Subject(s) - medicine , surgery , forearm , free flap , head and neck , fibula , cephalic vein , fistula , plastic surgery , vein , tibia
Background In a vessel‐depleted neck, distant recipient sites may be the only option for secondary free flap reconstruction. While interposition vein grafts and arteriovenous loops can bridge the gap between the recipient and donor pedicle, they are not without risks. In these scenarios, we examinate the reliablity of a radial forearm free flap (RFFF) as an alternative vascular conduit. Patients and methods A retrospective review of cases between March 2005 and May 2016 was performed. Demographic data, prior surgical history, intraoperative details and outcomes were recorded. A total of ten patients, eight male and two female, with a mean age of 54.2 years (range, 39–74) were identified. The RFFF was initially anastomosed to either the thoracoacromial ( n = 6) or internal mammary vessels ( n = 4) and subsequently served as the recipient pedicle for the second “main” flap, an anterolateral thigh ( n = 4), jejunum ( n = 3) or fibula flap ( n = 3). Results The average RFFF dimensions were 13.8 cm by 5.8 cm. All twenty flaps, ten RFFF and ten "main' flaps survived completely with only one case of minimal epidermal loss. One patient with esophageal reconstruction with jejunum developed a fistula that required closure with a local falp. At a mean follow‐up of 18.4 months (range 8–29), the reconstructive goals had been achieved in all cases. Conclusions The RFFF serves as a reliable “vascular bridge” that extends the reach of distant recipient sites to free flaps in secondary head and neck reconstruction.