Evans G R, Schusterman M A, Kroll S S, Miller M J, Reece G P, Robb G L, Ainslie N
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Am J Surg. 1994 Nov;168(5):446-50. doi: 10.1016/s0002-9610(05)80096-0.
The radial forearm free flap has become a workhorse flap in head and neck reconstruction. Its lack of bulk, ease of dissection, vascularity, and malleability are among its many advantages.
A review of 157 radial forearm free flaps performed in 155 patients between March 1988 and June 1994 at The University of Texas M.D. Anderson Cancer Center was undertaken to determine outcome. Patient age ranged from 22 to 80 years (mean 56). There were 79 men and 76 women. Follow-up ranged from 2 to 75 months. The most prevalent neoplasm was squamous cell carcinoma (n = 129).
The most frequent tumor staging was T3, N0, M0. Various defects were observed; however, those requiring floor-of-mouth coverage were most common (n = 95). Partial or segmental mandibular resection was seen in 42. An osseous component was included in the radial forearm flap in 9 patients, and 64 patients had undergone some form of previous tumor resection. Fifty-seven patients received preoperative irradiation and 52, postoperative. The internal jugular vein (n = 131) and the external carotid artery (n = 134) were the most frequent recipient sites for microvascular anastomosis. Vein grafts were needed in 4 cases, and end-to-side anastomoses were most commonly performed. Total flap loss occurred in 7 cases (4.5%) and partial flap loss in 1 (0.6%). For total flap loss, salvage was accomplished by a second radial forearm free flap in 2 cases and alternative rotational flaps in 5. Other complications (infection, hematoma, fistula formation, etc.) were seen in 34%. Donor-site difficulties were seen in 21 cases.
The radial forearm free flap offers a variety of reconstructive options for the head and neck. Its low flap loss and complication rates offer the best choice for oral lining restoration if bulk is not required.
桡侧前臂游离皮瓣已成为头颈部重建中常用的皮瓣。它的优点众多，包括体积小、易于解剖、血运丰富及可塑性强。
回顾1988年3月至1994年6月在德克萨斯大学MD安德森癌症中心对155例患者实施的157例桡侧前臂游离皮瓣手术，以确定手术效果。患者年龄在22至80岁之间（平均56岁）。男性79例，女性76例。随访时间为2至75个月。最常见的肿瘤是鳞状细胞癌（n = 129）。
最常见的肿瘤分期为T3、N0、M0。观察到各种缺损情况；然而，需要修复口底的情况最为常见（n = 95）。42例患者进行了部分或节段性下颌骨切除。9例患者的桡侧前臂皮瓣包含骨成分，64例患者曾接受过某种形式的肿瘤切除术。57例患者接受了术前放疗，52例接受了术后放疗。颈内静脉（n = 131）和颈外动脉（n = 134）是最常见的微血管吻合受区部位。4例患者需要静脉移植，最常进行的是端侧吻合。7例（4.5%）出现皮瓣完全坏死，1例（0.6%）出现部分皮瓣坏死。对于皮瓣完全坏死的情况，2例通过再次采用桡侧前臂游离皮瓣挽救，5例采用其他旋转皮瓣挽救。34%出现其他并发症（感染、血肿、瘘管形成等）。21例出现供区相关问题。
桡侧前臂游离皮瓣为头颈部提供了多种重建选择。如果不需要增加组织体积，其低皮瓣坏死率和并发症发生率使其成为口腔黏膜修复的最佳选择。
