The radial forearm flap as a carrier for the osteocutaneous fibula graft in mandibular reconstruction.
ABSTRACT According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.
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ABSTRACT: The incidence of malignancies in the head and neck region is rising. Head and neck tumors are the eighth most frequent type of malignancy in German men, forming 3.3% of the total. As a result, the demand for functionally successful and esthetically pleasing reconstructions has increased. Review based on a selective analysis of the pertinent literature and the guidelines of the German Association of Oral and Maxillofacial Surgery as well as the authors' clinical and scientific experience. Microsurgical flap transfer has become the most important type of reconstruction, with a more than 90% rate of success, i.e., complete integration of the transplant in the recipient site. The most frequent complications are thromboses of the vein or artery of the pedicle. For each specific defect constellation, the most appropriate donor sites have been identified. Some donor sites are used for more than one defect. The principal risk factors for flap loss are prior operations on the neck, atherosclerosis, and previous radiation treatment. New developments include the use of perforator flaps, which can be anastomosed to very small vessels in the face, and wrist-carriers, which offer complete independence from head and neck vessels. The treatment, rehabilitation, and follow-up care of patients with tumors of the head and neck must be carried out by an interdisciplinary team. Full awareness of the available options for reconstruction helps the radiation therapist, oncologist, psychooncologist, general practitioner, and dentist to coordinate their efforts and advise their often mutilated and sometimes suicidal patients effectively.Deutsches Ärzteblatt International 12/2008; 105(47):815-22. · 3.54 Impact Factor
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ABSTRACT: In an irradiated and vessel depleted neck, we used the wrist carrier technique to provide flap perfusion until autonomisation took place. A combined anterolateral thigh- and osteocutaneous fibular flap was anastomosed to the radial vessels of an irradiated patient with a vessel depleted neck for reconstruction of the lower face. Periodical pedicle occlusion started immediately after surgery. On day 16, cutaneous blood flow and oxygenation were still reduced, but wound healing was uneventful.Journal of Surgical Oncology 02/2009; 99(2):123-6. · 2.64 Impact Factor