College of Medicine, University of Florida, Gainesville, Florida, USA.
Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.
Microsurgery. 2023 Nov;43(8):767-774. doi: 10.1002/micr.31028. Epub 2023 Mar 9.
Utilization of free tissue transfers in head and neck reconstruction has greatly increased due to their dependability and reliability. Anterolateral thigh (ALT) and rectus abdominus (RA) free flaps may provide too much soft tissue bulk, especially in patients with a large body habitus. A radial forearm free flap (RFFF) may be modified with a "beaver tail" (BT), which provides a flap whose bulk may be tailored to a defect. The purpose of this paper is to describe the technique, how it can be used for a variety of defects and the outcomes of these reconstructions.
A retrospective review of prospectively collected data was performed at single tertiary care center between 2012 and 2022. BT-RFFF was designed by leaving a fibroadipose tail vascularized to branches of the radial artery or separated from the vascular pedicle and left attached to the proximal portion of the skin paddle. Functional outcomes, tracheostomy dependence, and gastrostomy tube (G-tube) dependence as well as complications were determined.
Fifty-eight consecutive patients undergoing BTRFFF were included. Defects reconstructed included: oral tongue and/or floor of mouth 32 (55%), oropharynx 10 (17%), parotid 6 (10%), orbit 6 (10%), lateral temporal bone 3 (5%), and mentum 1 (2%). Indications for BTRFF were: need for bulk when the ALT and RA were too thick (53%) and need for a separate subcutaneous flap for contouring or deep defect lining (47%). Complications directly related to beavertail included a widened forearm scar (100%), wrist contracture (2%) partial flap loss (2%), and flap loss requiring a revision flap (3%). Ninety-three percent of patients with oral/oropharyngeal defects and 12-month follow-up tolerated oral intake without aspiration and 76% were tube-independent. Ninety-three percent were tracheostomy-free at last follow-up.
The BTRFF is a useful tool for reconstructing complex 3D defects requiring bulk where an ALT or rectus would otherwise provide too much bulk.
由于游离组织移植在头颈部重建中的可靠性，其应用大大增加。股前外侧皮瓣（ALT）和腹直肌皮瓣（RA）游离皮瓣可能提供过多的软组织体积，尤其是在身体形态较大的患者中。游离前臂皮瓣（RFFF）可以通过“海狸尾”（BT）进行修改，该皮瓣可以提供一种体积可以根据缺损进行调整的皮瓣。本文旨在描述该技术，探讨其在各种缺损中的应用以及这些重建的结果。
在 2012 年至 2022 年期间，在一家三级医疗中心对前瞻性收集的数据进行了回顾性研究。BT-RFFF 通过留下一个带有血管的纤维脂肪尾，与桡动脉的分支相连或与血管蒂分离，并保留与皮瓣近端相连来设计。确定了功能结果、气管造口依赖、胃造口管（G-管）依赖以及并发症。
共纳入 58 例连续接受 BTRFFF 的患者。重建的缺损包括：口舌和/或口底 32 例（55%）、口咽 10 例（17%）、腮腺 6 例（10%）、眼眶 6 例（10%）、颞骨外侧 3 例（5%）和颏部 1 例（2%）。BT-RFFF 的适应证包括：当 ALT 和 RA 过厚时需要体积（53%），以及需要单独的皮下皮瓣进行轮廓或深部缺损衬里（47%）。与海狸尾直接相关的并发症包括前臂疤痕增宽（100%）、腕关节挛缩（2%）、部分皮瓣坏死（2%）和需要修复皮瓣的皮瓣坏死（3%）。93%的口腔/口咽缺损患者在 12 个月的随访中能够耐受无吸入的口服摄入，76%的患者无需依赖 G-管。93%的患者在最后一次随访时无需气管造口。
BTRFF 是一种有用的工具，可用于重建需要体积的复杂 3D 缺损，否则 ALT 或腹直肌会提供过多的体积。
