Osteocutaneous radial forearm free flap: its use without significant donor site morbidity.
While the fasciocutaneous radial forearm free flap has gained increasing popularity, the osteocutaneous radial forearm free flap has been condemned because of a high rate of pathologic donor radius fracture. On the basis of studies that demonstrated increased strength in ostectomized radii after dynamic compression plating, we believed that internal fixation at the time of graft harvest would significantly reduce the incidence of donor radius fracture. This is a retrospective review of the first 54 patients undergoing osteocutaneous radial forearm free flap reconstruction of the head and neck at our institution; 52 underwent prophylactic plating of their donor radii. No clinically significant donor radius fractures have occurred in plated patients. Five asymptomatic fractures were discovered on routine radiographs and required no treatment. Objective evaluation of forearm range of motion and strength after graft harvest demonstrated excellent function compared with unoperated arms. Serial radiographs have shown remodeling and reconstitution of donor radii without localized osteopenia.
Werle
A H
AH
Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Tsue
T T
TT
Toby
E B
EB
Girod
D A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016723:Bone Remodeling; D001863:Bone Screws; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D017102:Fracture Healing; D018737:Hand Strength; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000502:physiology / Q000637:transplantation*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000009:adverse effects* / Q000379:methods*; D013524:Surgical Flaps / Q000009:adverse effects*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome