title: Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap.
abstract: Objective This study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery. Study Design Prospective cohort study. Setting Plastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France. Subjects and Methods Despite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure. Conventional skin grafts for secondary tendon exposure can lead to diminished wrist range of motion and grip strength, with residual pain and cold intolerance. Between 2012 and 2015, we prospectively studied 20 patients with secondary tendon exposure after a forearm radial free flap for head and neck reconstruction. Two techniques of secondary coverage were compared: a reference technique with a secondary full skin graft (10 patients) and a dorsoulnar artery perforator (DUAP) flap (10 patients). Results Maximum wrist extension (100%) was observed for the DUAP group compared with only 87% for the skin graft (SG) group ( P = .001). An improvement in grip strength (+14 kg) ( P = .028) and a decrease in pain or cold intolerance ( P = .002) were also observed in the DUAP group, in addition to a better aesthetic appearance. Conclusion The perforator flap procedure is an interesting tool in reconstructive surgery. The DUAP flap is a reliable, useful flap for secondary tendon exposure coverage after a radial forearm free flap. Level of Evidence III (case-control analytic studies of 1 center).
authors.affiliation: 1 Plastic and Reconstructive and Hand Surgery Unit, Nice University Hospital, Nice, France.|2 Plastic and Aesthetic Surgery Center, Saint George Clinic, Nice, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Foissac
authors.affiliation: 1 Plastic and Reconstructive and Hand Surgery Unit, Nice University Hospital, Nice, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Benatar
authors.affiliation: 3 Head and Neck Reconstructive Surgery Unit, Head and Neck University Institute of Nice, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dassonville
authors.affiliation: 3 Head and Neck Reconstructive Surgery Unit, Head and Neck University Institute of Nice, Nice, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bozec
authors.affiliation: 3 Head and Neck Reconstructive Surgery Unit, Head and Neck University Institute of Nice, Nice, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Poissonnet
authors.affiliation: 1 Plastic and Reconstructive and Hand Surgery Unit, Nice University Hospital, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Camuzard
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply / Q000601:surgery*; D058752:Free Tissue Flaps / Q000009:adverse effects; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013708:Tendon Injuries / Q000601:surgery; D060053:Transplant Donor Site / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: dorsoulnar artery perforator flap; head and neck reconstruction; radial forearm free flap; secondary tendon exposure; skin graft