Application of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection / 中华肿瘤杂志

Objective: To evaluate the effect of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection. Methods: From June 2016 to December 2019, 12 patients with defect after resection of mouth floor cancer were treated with trifoliate flap design of radial forearm flap. All of these patients were T2 stage, included 9 well-differentiated squamous cell carcinoma (SCC) and 3 moderate differentiated SCC. The defect size ranged from 8.0 cm×6.0 cm to 5.0 cm×4.5 cm after resection of tumor and neck dissection. All defects were repaired with trifoliate flap design of radial forearm flap. The flap size ranged from 8.0 cm×2.0 cm to 4.0 cm×1.5 cm, the donor site was sutured directly on Z plasty. Results: All flaps completely survived well. Both the wound and the donor site were stage Ⅰ healing. With the average follow-up of 38.6 months, the swallowing and speech function were satisfactory. Conclusions: Trifoliate flap design of radial forearm flap can effectively repair the postoperative defect of mouth floor cancer, and the donor site can be directly sutured on Z plasty. This technique can avoid forearm scar caused by skin grafting and the formation of the second donor site.

Reconstrucción lingual con colgajo libre radial: A propósito de un caso

Resumen El cáncer de lengua es una patología con una importante morbilidad e impacto en la calidad de vida del paciente, afectando la masticación, deglución, comunicación y gusto, por lo que requiere de un equipo multidisciplinario para establecer la rehabilitación adecuada. Se necesita realizar resecciones amplias para asegurar márgenes negativos, y si el cirujano considera que existe un volumen remanente insuficiente para obliterar la cavidad oral, la realización de un colgajo será necesario para mantener la función deglutoria. Se presenta el caso de un paciente de 76 años, masculino, con antecedentes de tabaquismo suspendido hace 23 años, que presenta una lesión ulcerada dolorosa en el borde derecho de la lengua móvil, la biopsia informa un carcinoma epidermoide, etapificado T2N0M0, por lo que se decide realizar hemiglosectomía derecha más disección cervical y reconstrucción con colgajo libre radial.

Abstract Tongue cancer is a pathology with significant morbidity and impact on the quality of life of the patients. It affects chewing, swallowing, communication, and taste. Therefore, a multidisciplinary team is required to establish adequate rehabilitation. Extensive resections are needed to ensure negative margins. If the surgeon considers that there is insufficient remaining volume to obliterate the oral cavity, flap surgery will be carried out to maintain the swallowing function. We present a case report of a 76-year-old male patient with a history of smoking cessation of 23 years. He presents a painful ulcerated lesion on the right edge of the mobile tongue. The biopsy reports an epidermoid carcinoma, staged T2N0M0 which led to perform a right hemiglosectomy, cervical dissection, and reconstruction with free radial forearm flap.

Functional Assessment: Speech and Swallowing Outcomes after Free Radial Forearm Reconstruction for Hemiglossectomy Defects

Background: To evaluate the speech and swallowingoutcomes after free radial forearm reconstruction forhemiglossectomy defects.Patients and Methods: The clinicopathologic data of 10tongue carcinoma cases hospitalized from November 2015 toDecember 2018 in American International Institute of MedicalSciences, Udaipur (Raj.). There were 7 male patients and 3female patients with age ranging from 40-65 years old. Thesepatients underwent simultaneous hemiglossectomy andintraoral defects reconstruction with Forearm Radial Free flap.Mandible was not resected in any of the patients. All subjectswere evaluated 3 months postoperatively.Results: There was vascular crisis in 1 case, and secondarytreatment was taken to rescue the flap. The donor sites wereclosed with grafted skin. In 3 cases, a partial grafted skin losswas observed and the donor sites healed after a long timeunder local wound care. 2 cases suffered from numbness infingers to some degree.Conclusion: When compared with primary closure of the postexcisional defect of the tongue, it is better to reconstruct thedefect with free radial forearm flap. The overall satisfaction ofthe patients in regards to function and cosmesis in tonguereconstruction was high when using free tissue transfer in theform of free radial forearm flap following wide localoncosurgical resection

Clinical application of the bilateral radial forearm flap for tongue cancer reconstruction / 中华口腔医学杂志

The forearm radial flap is a reliable flap for the repair of the defect caused by tongue cancer resection. The clinical data of 11 tongue cancer patients that received this surgery were retrospectively analyzed. The clinical application of this technique is preliminarily discussed.

Comparison of the subjective satisfaction of free radial forearm flap and anterolateral thigh flap for the donor site after surgical reconstruction in tongue cancer patients / 天津医药

Objective To compare the subjective satisfaction of the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) of the donor site after surgical reconstruction for tongue cancer. Methods A total of 121 consecutive patients underwent FRFF or ALTF reconstruction after ablative surgery for untreated, primary tongue squamous cell carcinoma at Tianjin Stomatological Hospital and Peking University School and Hospital of Stomatology from August 2011 to October 2014 were enrolled in this study. The subjective satisfaction of the donor site, including sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life (QOL), was assessed by a self-established donor site morbidity questionnaire from October 2016 to January 2017. Results Of the 121 patients, 34 died because of cancer or other diseases, 2 were excluded because of recurrence after reconstruction surgery, 11 lost to contact, and 74 (61.2％) completed the questionnaires finally, which included 39 patients in FRFF group and 35 patients in ALTF group. The scores for sensibility, cosmetics, general impacts on the QOL and composite score were significantly higher in ALTF group than those of FRFF group (P<0.05). No significant differences were found in the movement disabilities and social activities between the two groups (P > 0.05). Conclusion ALTF has the advantage of better results of donor site morbidity, less adverse effect on the general QOL, and higher subjective satisfaction.

Experiencia en microcirugia reconstructiva en el Servicio de Cirugía Plástica del Hospital Solca Quito Solón Espinosa Ayala / Experience in reconstructive microsurgery at the Plastic Surgery Service of Solca Quito Hospital Solon Espinosa Ayala

Introducción: la microcirugía desde sus inicios en los años 60s ha tenido un avance importante, ha ganado popularidad y es aceptada en la reconstrucción de tejidos blandos y óseos, ya que se pueden resolver defectos antes imposibles de reconstruir. Materiales y métodos: se realizó un estudio retrospectivo observacional de 161 casos de reconstrucción microquirúrgica en pacientes sometidos a cirugía ablativa por cáncer, en el Hospital Solón Espinosa Ayala "SOLCA" Quito durante el período 2011 y 2016 por un solo cirujano plástico y reconstructivo. Es el primer estudio que analiza el éxito en colgajos microvascularizados con reporte de 161 casos en el Ecuador. Resultados: en un total de 161 pacientes, se realizó 161 reconstrucciones con colgajos microquirúrgicos, encontrando una tasa de éxito del 95,65%, complicaciones mayores en 3,11% y complicaciones menores en 21,74%. Conclusiones: la transferencia de tejido libre ha revolucionado la reconstrucción de defectos complejos de diversa etiología, la tasa presentada de éxito en reconstrucciones microquirúrgicas es similar a las descritas internacionalmente. (AU)

Introduction: Microsurgery since its inception in the 60s has had a major breakthrough, has gained popularity and is accepted in the reconstruction of soft tissue, as can be solved by this technique to reconstruct defects previously impossible. Materials and methods: An observational retrospective study of 161 cases of microsurgical reconstruction was performed mainly in patients undergoing ablative cancer surgery, especially in the Solón Espinosa Ayala Hospital "SOLCA" Quito between the period 2011 and 2016 by a single plastic and reconstructive surgeon it is the first study that analyzes the success in microvascular flaps with report of 161 cases in Ecuador. Results: A total of 161 patients, 161 reconstructions were performed with microsurgical flaps, finding a success rate of 95.65%, major complications in 3.11% and minor complications by 21.74%. Conclusions: free tissue transfer has revolutionized the reconstruction of complex defects of diverse etiology, the success rate in microsurgical reconstructions is not related to increased surgeon experience, but with inherent talent. (AU)

Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps.</p><p><b>METHODS</b>The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radial-based fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t-
test to perform statistical analysis with SPSS 19.0 statistical software package.</p><p><b>RESULTS</b>Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation.</p><p><b>CONCLUSIONS</b>Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.</p>

Comparison of the quality of life between patients underwent reconstruction after hemiglossectomy using infrahyoid myocutaneous flap and radial forearm flap / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVEThis study was designed to compare the quality of life between patients who underwent a tongue reconstruction with radial forearm flap (RFF) and infrahyoid myocutaneous flap (IHMCF) after hemiglossectomy for their tongue cancers, and to figure out an optimal reconstructive method for the defects resulted from hemiglossectomy.METHODSA non-randomized case-control study was performed on 24 patients with tongue squamous cell carcinoma who underwent a standard hemiglossectomy combined with perfectly tongue reconstruction from June 2005 to June 2012. All of the cases were without tongue base invasion. Of the 24 cases, 19 had T2 disease, 5 had T3 disease, and they were divided into RFF group (n=10) and IHMCF group (n=14). The quality of life were evaluated one year after operation using EORTC-QLQ30 and FACT-H&N35 and compared between the two groups.RESULTSThe scores were comparable between the two group with regard to all domains of EORTC-QLQ30,with all P values>0.05.The scores of swallowing(P=0.005), speech (P=0.008), teeth (P=0.014), and cough (P=0.009) domains were significantly higher in IHMCF group than in RFF group, with P value of 0.005, 0.008, 0.014 and 0.009 respectively, while the other domains of FACT-H&N35 were comparable between the two groups, with allP values>0.05.CONCLUSIONOverall quality of life was similar in the two groups. Oral function domains were better in IHMCF group than in RFF group. When guarantee of flap survival is available, IHMCF could be used as a good alternative flap to RFF in tongue reconstruction after hemiglossectomy.

Lower Eyelid Full-Thickness Reconstruction Using a Radial Forearm Free Flap with Palmaris Longus Tendon Sling: A Case Report

PURPOSE: Many advances have been made in lower eyelid reconstruction surgical procedures after tumor ablative therapy. These include skin grafts, local flaps, free flaps, and skin expansion. When a full-thickness defect of the lower eyelid is reconstructed with many free flaps, ectropion and deformity of the medial and lateral canthal areas are common late complications caused by gravitational descent. The radial forearm free flap is widely used because of its lack of bulk, ease of dissection, malleability, and hairlessness. This report introduces a novel method for preventing ectropion using a composite radial forearm free flap reconstruction and palmaris longus suspension technique. METHODS: A 70-year-old man had a malignant melanoma on his left lower eyelid. The patient was referred to our department after a biopsy confirmed the initial diagnosis. A full-thickness wide resection with a 25 mm free margin was performed, and a 5 x 8 cm radial forearm flap was elevated with a vascularised palmaris longus tendon. The palmaris longus tendon was fixed to the medial and lateral orbital rim perisoteum and the deep temporal fascia. The buccal mucosa was grafted to reconstruct the inner conjunctival layer. The pedicle vessels were anastomosed to the left superficial temporal artery and vein. RESULTS: The postoperative clinical course was uneventful. The flap showed good texture and color match. No ectropion was noted 14 months after surgery and the tumor did not recur. The patient was quite satisfied with the final outcomes. CONCLUSION: Use of a radial forearm free flap and the palmaris longus tendon is an effective method for a full-thickness lower eyelid reconstruction.

Treatment of Talipes Equinus Deformity Using Free Radial Forearm Flap and Achilles Tendon Lengthening

PURPOSE: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. METHODS: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis (Terudermis(R)) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). RESULTS: The size of flaps varied from 6x12 to 15 x12cm (average, 12x7.8cm). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with Terudermis(R) were aesthetically better than those having skin grafts only. CONCLUSION: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.

A case report of Synovial sarcoma

A malignant sarcoma of soft tissue that arises near but not in a joint, most often in an adolescent or young adult, is typically slowgrowing, and may escapes notice until it causes pain. The diagnosis of this tumor can be suspected by X-ray or imaging, made by biopsy, and confirmed by chromosome studies. Cytogenic studies reveal a translocation between the X chromosome and chromosome 18 in the tumor cells. The most common treatment for the tumor is surgery to remove the entire tumor, nearby muscle, and lymph nodes. Synovial sarcoma tends to recur locally and to involve regional lymph nodes. Distant metastasis occurs in half cases. The well-documented and adequately followed cases are currently lacking and this report described an instance of Synovial sarcoma good result after treatment and review of literature.

Reconstruction of the oral and maxillofacial soft tissue defect by microsurgical technique / 中华医学美学美容杂志

Objective To reconstruct the oral and maxillofacial defects with the radial forearm flaps. Methods 12 patients suffered from the oral and maxillofacial soft tissue defects caused by various reasons had undergone the reconstruction by microsurgical techniques to implant the free radial forearm flaps for repair of the defects. Assessment was given to the results of the reconstructions of the oral and maxillofacial defects. Results The appearance, plump and countenance functions of the maxillofacial region were regained. The oral functions were improved obviously. 11 of 12 patients’ defects (91.66%) were reconstructed successfully. Conclusion The radial forearm flap is an excellent option especially for the repair and reconstruction of the oral and maxillofacial multiple-angle, irregular and complicated defects.

One-Stage Microsurgical Phalloplasty using the Free Radial Forearm Osteocutaneous Sensory Flap / 대한비뇨기과학회지

We performed one-stage microsurgical phalloplasty on a 17-year-old male-pseudohermaphroditism patient after bilateral orchiopexy and urethroplasty, using the free radial forearm osteocutaneous sensory flap. The main advantages of this technique are not only the one-stage reconstruction and the satisfactory cosmetic and functional solution, but also the possibility of obtaining normal erogenous and tactile sensibility. One week after the operation, the urethrocutaneous fistula was developed between the native proximal urethra and the constructed neourethra, but seven weeks after the development, it spontaneously healed well. The results of our S-month follow-up are satisfactory in the following respects : 1) satisfactory cosmetic appearance 2) voluntary control of transurethral urination while standing 3) tactile and thermal sensibility. Further follow-up study is necessary for the confirmation of erogenous sensibility, successful sexual life and late complication.

Treatment of Soft Tissue Defect on Dorsum of hand by Using the Reverse Radial Forearm Flap: Report of 5 Cases / 대한정형외과학회잡지

Soft tissue defect on dorsum of hand requires immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. If the tendon or bone was exposed and the deep structures were absent, flap was required to provide adequate protection and allow proper function of the underlying structures. Small size in skin loss can easily be covered with local flaps but major defects involving the dorsal aspect of the hand should be coverd with distant flaps, free flaps or radial forearm flaps. Techniques in distant flaps require staged procedures and free flap transfer to obtain soft tissue cover in a single stage require microsurgical techniques. The reverse radial forearm flap is a fasciocutaneous flap based on the radial artery which together with its two venae comitantes lies invested in a condensation of the deep fascia known as the lateral intermuscular septum. The authors had treated 5 cases of distally based reverse forearm flap for soft tissue reconstruction on 2 patients of crushing injury with soft tissue defect on hand, a patient with Marjolin's ulcer on dorsum of hand due to previous burn scar and a patient with soft tissue necrosis on dorsum of both hands due to extravasation of adriamycin during chemotherapy. It has proved to be one of the saftest, simple and effective one-stage method of soft tissue reconstruction in hand without long term immobilization. The results of these operation in cover of soft tissue defect have been satisfactory.