Savant D N, Patel S G, Deshmukh S P, Gujarati R, Bhathena H M, Kavarana N M
Department of Plastic Surgery, Tata Memorial Hospital, Bombay, India.
Head Neck. 1995 Jul-Aug;17(4):293-6. doi: 10.1002/hed.2880170404.
Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. We report a modified technique of folding the radial forearm flap for reconstruction of full-thickness defects of the cheek.
The free radial forearm flap is a type C fasciocutaneous flap based on the radial artery along with its vena commitans and superficial forearm vein. The size and shape of the flap are determined according to the dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is then performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent fill-thickness excision of the cheek.
Flap edema was observed in 4 patients in the immediate post-operative period. Necrosis of the outer paddle was seen in 1 patient. Donor site morbidity was seen in 4 patients who required dressings on an outpatient basis for up to 3 weeks.
Single-stage reconstruction of full-thickness defects of the cheek with the folded free radial forearm flap is reliable and produces excellent cosmesis with minimal donor site morbidity.
传统上，颊部全层缺损采用折叠前额皮瓣、颈部皮瓣、胸大肌肌皮瓣或三角胸皮瓣等多种组合进行修复。我们报告一种改良的折叠桡动脉前臂皮瓣技术用于修复颊部全层缺损。
游离桡动脉前臂皮瓣是一种基于桡动脉及其伴行静脉和前臂浅静脉的C型筋膜皮瓣。根据手术缺损的大小确定皮瓣的尺寸和形状。然后将皮瓣连同前臂筋膜掀起，使其成为筋膜皮瓣，其中桡动脉位于筋膜深层并发出许多分支。仅在准备好受体血管进行吻合后，才将皮瓣与供体部位分离。然后使用手术显微镜进行血管吻合。该技术用于13例颊黏膜癌患者，这些患者接受了颊部全层切除。
4例患者术后即刻出现皮瓣水肿。1例患者外侧皮瓣坏死。4例患者出现供体部位并发症，需要门诊换药长达3周。
采用折叠游离桡动脉前臂皮瓣一期修复颊部全层缺损可靠，美容效果极佳，供体部位并发症最少。
