Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyengju, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, Daehakro 101, Jongno-gu, Seoul 03080, South Korea.
Auris Nasus Larynx. 2022 Oct;49(5):862-867. doi: 10.1016/j.anl.2022.03.011. Epub 2022 Mar 20.
The objectives of this study were to evaluate the reliability of a strip design as a monitoring flap in buried flap and to investigate whether strip design of radial forearm free flap (RFFF) could affect donor site morbidity in East Asian.
Patients with externalized flap in buried RFFF were consecutively included in this study. For cases with mucosal defect repair, a skin strip with a 1.5 cm width was proximally positioned to the primary flap along with the pedicle. Compared to a mucosal defect, a skin strip was distally positioned overlying the pedicle (near the wrist) when the flap was used for reinforcing the facial contour, reconstructing sacrificed facial nerve, or reanimating facial expression. The externalized flap formation was performed after completion of anastomoses of vessels. Monitoring results of flap failure using an externalized monitoring flap and additional morbidity of donor site were evaluated.
Nine patients were included in this study. Although there were two cases of pharyngeal fistula due to mucosal necrosis of resection margin, transferred RFFF was viable in all cases. The externalized flap provided reliable monitoring for the buried RFFF without a case of necrosis even in two cases with a partial detachment of septocutaneous branches between the radial artery and the designed skin strip. There was no false - positive case. Therefore, the sensitivity and positive predictive value of the externalized monitoring flap were 100%. All defects of radial forearm caused by skin strip harvest were also primarily closed without an additional skin graft.
A strip design for externalized monitoring flap in RFFF can facilitate an easier creation of externalized monitoring flap in cases with buried RFFF without additional morbidity at the donor site compared to a conventional techniques.
本研究旨在评估皮条设计作为埋藏皮瓣监测瓣的可靠性，并探讨桡侧前臂游离皮瓣（RFFF）的皮条设计是否会影响东亚供区的发病率。
本研究连续纳入外展皮瓣的埋藏 RFFF 患者。对于黏膜缺损修复，在皮瓣与蒂部之间沿皮瓣近端位置设计 1.5cm 宽的皮条。与黏膜缺损相比，当皮瓣用于增强面部轮廓、重建牺牲的面神经或重新激活面部表情时，皮条在蒂部（靠近手腕）远端覆盖皮瓣。在完成血管吻合后进行外展监测瓣的皮瓣形成。评估使用外展监测瓣的皮瓣失败监测结果和供区的额外发病率。
本研究纳入 9 例患者。尽管有 2 例因切除缘黏膜坏死导致咽瘘，但所有转位的 RFFF 均存活。外展瓣为埋藏的 RFFF 提供了可靠的监测，即使在桡动脉和设计皮条之间的皮动脉和皮动脉之间存在部分分离的情况下，也没有发生一例坏死。没有假阳性病例。因此，外展监测瓣的敏感性和阳性预测值均为 100%。由于皮条采集引起的所有桡侧前臂缺损也均一期闭合，无需额外植皮。
与传统技术相比，RFFF 中用于外展监测瓣的皮条设计可在埋藏 RFFF 中更容易地创建外展监测瓣，而不会增加供区的发病率。
