Menichini Giulio, Calabrese Sara, Alfonsi Nicola, Innocenti Marco
Department of Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.
Arch Plast Surg. 2021 Nov;48(6):646-650. doi: 10.5999/aps.2021.00486. Epub 2021 Nov 15.
Head and neck reconstruction poses unique challenges in rehabilitating surgical defects in terms of integrity, function, and form. The radial forearm free flap (RFFF) has been widely used for defect coverage, especially in the head and neck area, but its versatility allows it to be used for soft-tissue reconstruction in various parts of the body. The vascular features of the flap are quite constant and reliable. Nevertheless, abnormalities of the forearm vascular tree have been described over the decades. We report a case of intraoral reconstruction after verrucous carcinoma recurrence in a 74-year-old woman with an unusual forearm flap, which we called the median forearm free flap, based on a median branch of the radial artery that was preoperatively detected using handheld Doppler ultrasonography. The distally located skin paddle was predominantly supplied by the aberrant median vessel with its perforators. The flap was thus safely harvested with this atypical pedicle. Successful reconstruction of the intraoral defect was achieved, with an uneventful postoperative course.
头颈部重建在修复手术缺损的完整性、功能和形态方面面临独特挑战。桡侧前臂游离皮瓣（RFFF）已广泛用于缺损覆盖，尤其是在头颈部区域，但其多功能性使其可用于身体各部位的软组织重建。该皮瓣的血管特征相当恒定且可靠。然而，几十年来一直有前臂血管树异常的描述。我们报告了一例74岁女性疣状癌复发后的口腔内重建病例，该患者采用了一种不寻常的前臂皮瓣，我们称之为前臂正中游离皮瓣，其基于桡动脉的正中分支，术前通过手持多普勒超声检测到。位于远端的皮瓣主要由异常的正中血管及其穿支供血。因此，利用这个非典型蒂安全地切取了皮瓣。成功完成了口腔内缺损的重建，术后过程顺利。
