Radial forearm free flap shows worth in mandibular reconstruction

By Liam Davenport, medwireNews Reporter

The osteocutaneous radial forearm free flap (OCRFFF) should be used for mandibular reconstruction because of the low rate of long-term donor and recipient site complications, particularly with prophylactic plating of the donor radius, say US scientists.

The team, led by Jill Arganbright (University of Kansas Medical Center, Kansas City), comments: "We have shown that harvest of 50% of the donor radius width with up to 12 cm of length can safely be performed without increased morbidity. Prophylactic plating of the donor radius has nearly eliminated the risk of pathologic radial bone fractures."

They add: "This study shows limited long-term donor and recipient site complications, supporting this flap as a useful option for single-stage mandibular re-construction."

The team conducted a retrospective review of 167 patients, with a mean age of 61 years, who underwent single-staged mandibular reconstruction with an OCRFFF between 2000 and 2010. The overall flap success rate was 99%, they report in JAMA Otolaryngology - Head & Neck Surgery.

The most common indication for surgery was squamous cell carcinoma (77% of patients), while other indications included osteoradionecrosis (11%), trauma (3%), and odontogenic tumors (3%).

The median length of bone harvested was 7 cm, and prophylactic plating was performed for each of the radii at the time of harvest using a 3.5 mm low-contact dynamic compression plate. The harvested radial bone underwent up to two osteotomies to achieve the appropriate mandibular contour.

The most common donor site complication was tendon exposure, which occurred in 28% of patients, followed by hand weakness and/or numbness (9.0%), wound infection (5.0%), radial hardware infection (1.0%), and radial fracture (0.5%).

For recipients, the most common site complication was mandible hardware exposure, seen in 17% of patients. Other complications were flap revision (13%), wound infection (6%), hardware infection (2%), bone or plate fracture (2%), malunion or nonunion (2%), and flap failure (1%).

On regression analysis, hardware exposure was not related to age, gender, chemotherapy, plate size, or history of radiation therapy. Patients were found to be a significant 1.3 times more likely to have plate exposure for every 1-cm increase in bone harvest length.

However, the team concedes that "larger studies are needed to further delineate the actual predictive nature of these variables."

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