Secondary maxillofacial reconstruction with the radial forearm free flap: a standard operating procedure for the venous microanastomoses.
BACKGROUND
The radial forearm free flap (RFFF) is commonly used in reconstructive surgery. With respect to the maxillofacial region, several venous anastomotic techniques (e.g., single or double anastomoses) have been described, but the debate as to which alternative is preferable is ongoing. A complicating factor is the unpredictable anatomical situation in patients undergoing secondary operation. No recommendations are available for the surgical strategy in such cases. We present a standard operating procedure (SOP) applicable for secondary reconstructions, postulating double anastomoses as the method of choice, and evaluate its efficacy.


METHODS
The following parameters were retrospectively analyzed for 120 patients with secondary (41; 34.2%) or primary (79; 65.8%) reconstruction following the instructions of SOP and compared between the study groups: age; sex; history of radiotherapy; side of the donor arm; flap size; preparation and use of the cephalic vein and reasons for its non-inclusion; included venae comitantes; recipient veins; arterial anastomoses; revisions, flap survival, and mortality within thirty days after operation.


RESULTS
The method of choice was applicable in 26 (63.4%) secondary and 52 (65.8%) primary reconstructions (no difference; P = 0.841), resulting in 100% flap viability in both groups. In the remaining cases, single venous anastomoses were performed, resulting in 73.3% flap viability in secondary and 100% in primary reconstructions. Flap survival in secondary reconstructions was significantly higher when double anastomoses were conducted (P = 0.012).


CONCLUSIONS
The results suggest the necessity of double venous anastomoses in secondary maxillofacial reconstructions with RFFF.
Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany. rohleder@mkg.med.tum.de
Nils H
NH
Rohleder
Klaus D
KD
Wolff
Frank
F
Hölzle
Stefan
S
Wagenpfeil
Craig J
CJ
Wales
Rafael J
RJ
Hasler
Marco R
MR
Kesting
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014680:Veins / Q000601:surgery*