Van Kouwenberg Emily A, Yan Alan, Patel Ashit, McLaughlin Rick L, Northrup Patricia, Cintron Melanie, Agag Richard L
Division of Plastic Surgery, Albany Medical Center, Albany, New York.
Division of Cardiothoracic Surgery, Albany Medical Center, Albany, New York.
J Reconstr Microsurg. 2019 Jan;35(1):22-30. doi: 10.1055/s-0038-1653983. Epub 2018 Jun 12.
The radial forearm free flap (RFFF) remains a workhorse flap but can have significant donor site morbidity. The authors developed a novel technique for endoscopic-assisted RFFF (ERFFF) harvest and hypothesized improved donor site morbidity.
A retrospective cohort study was conducted evaluating patients who underwent ERFFF or RFFF by a single surgeon for head and neck reconstruction between November 2011 and July 2016; outcomes and complications were compared. A telephone survey was conducted to assess patient satisfaction with donor site appearance and function.
Twenty-seven ERFFF and 13 RFFF harvests were performed. The cephalic vein was less commonly incorporated in ERFFF patients compared with RFFF patients (3.70 and 38.46%, respectively, = 0.0095). ERFFF patients had lower rates of wound healing complications (0% vs. 15.38%, = 0.10) and perfusion-related complications than RFFF patients (3.70% vs. 23.08%, = 0.092). Fewer ERFFF patients reported a desire for a more normal appearance (42.86% vs. 71.43%, = 0.361). The ERFFF group had a higher functional score (64.29% vs. 44.44%, = 0.101), reporting lower rates of associated discomfort (35.71% vs. 85.71%, = 0.063). None of the differences in rates of complications or patient-reported outcomes between the groups reached statistical significance.
ERFFF is safe and effective alternative to RFFF, with similar operative time, similar pedicle safety, and elimination of the lengthy forearm incision. Unnecessary cephalic vein dissection can be avoided with endoscopic visualization of the venae comitantes. Further research with a larger sample size and better standardization is needed to assess effects on donor-site morbidity.
桡侧前臂游离皮瓣（RFFF）仍然是一种常用皮瓣，但供区可能出现明显的并发症。作者开发了一种用于内镜辅助下切取RFFF（ERFFF）的新技术，并推测其供区并发症会有所改善。
进行一项回顾性队列研究，评估2011年11月至2016年7月期间由同一外科医生为头颈重建实施ERFFF或RFFF的患者；比较其结果和并发症情况。进行电话调查以评估患者对供区外观和功能的满意度。
共进行了27例ERFFF切取和13例RFFF切取。与RFFF患者相比，ERFFF患者较少包含头静脉（分别为3.70%和38.46%，P = 0.0095）。ERFFF患者的伤口愈合并发症发生率低于RFFF患者（0%对15.38%，P = 0.10），灌注相关并发症发生率也低于RFFF患者（3.70%对23.08%，P = 0.092）。较少ERFFF患者表示希望外观更正常（42.86%对71.43%，P = 0.361）。ERFFF组功能评分更高（64.29%对44.44%，P = 0.101），报告相关不适发生率较低（35.71%对85.71%，P = 0.063）。两组之间并发症发生率或患者报告结局的差异均未达到统计学意义。
ERFFF是RFFF的一种安全有效的替代方法，手术时间相似，蒂部安全性相似，且无需前臂长切口。通过内镜观察伴行静脉可避免不必要的头静脉解剖。需要进行更大样本量和更好标准化的进一步研究来评估对供区并发症的影响。
