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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2011

01-07-2011 | Head and Neck Oncology

Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses

Authors: Nils H. Rohleder, MD, Klaus D. Wolff, MD, Frank Hölzle, MD, Stefan Wagenpfeil, MSc, Craig J. Wales, FRCS, Rafael J. Hasler, DDS, Marco R. Kesting, MD

Published in: Annals of Surgical Oncology | Issue 7/2011

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Abstract

Background

The radial forearm free flap (RFFF) is commonly used in reconstructive surgery. With respect to the maxillofacial region, several venous anastomotic techniques (e.g., single or double anastomoses) have been described, but the debate as to which alternative is preferable is ongoing. A complicating factor is the unpredictable anatomical situation in patients undergoing secondary operation. No recommendations are available for the surgical strategy in such cases. We present a standard operating procedure (SOP) applicable for secondary reconstructions, postulating double anastomoses as the method of choice, and evaluate its efficacy.

Methods

The following parameters were retrospectively analyzed for 120 patients with secondary (41; 34.2%) or primary (79; 65.8%) reconstruction following the instructions of SOP and compared between the study groups: age; sex; history of radiotherapy; side of the donor arm; flap size; preparation and use of the cephalic vein and reasons for its non-inclusion; included venae comitantes; recipient veins; arterial anastomoses; revisions, flap survival, and mortality within thirty days after operation.

Results

The method of choice was applicable in 26 (63.4%) secondary and 52 (65.8%) primary reconstructions (no difference; P = 0.841), resulting in 100% flap viability in both groups. In the remaining cases, single venous anastomoses were performed, resulting in 73.3% flap viability in secondary and 100% in primary reconstructions. Flap survival in secondary reconstructions was significantly higher when double anastomoses were conducted (P = 0.012).

Conclusions

The results suggest the necessity of double venous anastomoses in secondary maxillofacial reconstructions with RFFF.
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Metadata
Title
Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses
Authors
Nils H. Rohleder, MD
Klaus D. Wolff, MD
Frank Hölzle, MD
Stefan Wagenpfeil, MSc
Craig J. Wales, FRCS
Rafael J. Hasler, DDS
Marco R. Kesting, MD
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1555-0

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