Riecke Björn, Kohlmeier Carsten, Kreiker Henri, Suling Anna, Assaf Alexandre Thomas, Wikner Johannes, Hanken Henning, Heiland Max, Gröbe Alexander, Rendenbach Carsten
Department of Oral & Maxillofacial Surgery (Head: Max Heiland, MD, DMD, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Department of Medical Biometry and Epidemiology (Head: Karl Wegscheider, PhD), University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
J Craniomaxillofac Surg. 2015 Nov;43(9):1776-80. doi: 10.1016/j.jcms.2015.07.039. Epub 2015 Aug 6.
Although the radial forearm free flap (RFF) is a commonly used microvascular graft for head and neck reconstruction, long-term biomechanical results regarding donor site morbidity are rare.
In a prospective panel study, 32 patients were included. Biomechanical assessment was performed preoperatively, three months postoperatively and two years postoperatively. The primary endpoint of the study was grip strength. In addition, the Mayo wrist score, DASH score (disabilities of the arm, shoulder and hand score), fine motor skill strengths (tip pinch, key pinch, palmar pinch) and the range of motion were analysed. Primary defects were closed with local full-thickness skin grafts (FTSG) from the donor site forearm avoiding a secondary defect site.
In the long-term analysis, grip strength was reduced in both arms. A significant improvement over time was found only for the donor arm. A persistent deficit of tip pinch strength and dorsal extension was recorded. Persistent sensory limitations occurred in four cases. Patient contentment after two years of follow-up was high and daily life routine was not restricted.
Gross and fine motor skill limitations are reversible short-term effects after RFF harvesting and do not restrict daily routine in the long term. These findings substantiate the value of the RFF as a workhorse in reconstructive surgery.
尽管桡侧前臂游离皮瓣（RFF）是用于头颈部重建的常用微血管移植物，但关于供区并发症的长期生物力学结果却很少见。
在一项前瞻性分组研究中，纳入了32例患者。在术前、术后3个月和术后2年进行生物力学评估。该研究的主要终点是握力。此外，还分析了梅奥腕关节评分、DASH评分（手臂、肩部和手部功能障碍评分）、精细运动技能强度（指尖捏力、钥匙捏力、手掌捏力）和活动范围。主要缺损采用供区前臂的局部全厚皮片（FTSG）闭合，避免出现二次缺损部位。
在长期分析中，双臂的握力均下降。仅供侧手臂随时间有显著改善。记录到指尖捏力和背伸持续不足。4例出现持续的感觉障碍。随访两年后患者满意度较高，日常生活未受限制。
RFF切取后，粗大和精细运动技能受限是可逆的短期效应，长期来看并不限制日常生活。这些发现证实了RFF作为重建手术中主力术式的价值。
