Hand perfusion following radial or ulnar forearm free flap harvest for oral cavity reconstruction: A prospective study.

The radial forearm free flap (RFFF) and ulnar forearm free flap (UFFF) are used in head and neck reconstruction because they provide a thin and pliable skin paddle as well as a long vascular pedicle. However, in spite of several studies showing the safety of the UFFF, the RFFF is more popular among reconstructive surgeons based on concerns about hand ischaemia. A prospective study was designed in which 10 UFFF and 11 RFFF surgeries were performed in 20 patients undergoing oral cavity reconstruction between January 2017 and July 2018. Hand vascular parameters were evaluated preoperatively and postoperatively using Doppler ultrasound and plethysmography. The preoperative and postoperative diameters of the radial and ulnar arteries, and the flow velocities through the remainder of the forearm artery were measured preoperatively and at 3 months postoperative. Additionally, a comparison was performed between the preoperative and postoperative fingertip perfusion values according to impedance plethysmography. The preoperative mean diameter of the radial artery (2.89±0.47mm) was significantly greater than that of the ulnar artery (2.35±0.48mm) at the level of the wrist; however, 3 months after the surgery, the mean diameters of the two arteries did not differ significantly. There were no differences in digital perfusion when a UFFF was used compared with an RFFF.

Use of Integra in oral reconstruction: a case series.

OBJECTIVE: Small intraoral defects are usually reconstructed using skin autografts. However, the goal of this research was to describe an alternative to classic techniques using artificial dermis (Integra) in the reconstruction of these types of injuries. MATERIALS AND METHODS: Four patients with small intraoral lesions in different locations underwent resection. The created defects were covered with a bilayer of Integra; then, a chlorhexidine stent cure (Laboratorios Salvat, Barcelona, Spain) was applied. The patients were followed up daily during the first week to detect any signs of infection, dehiscence, or loss of the lamina. Thereafter, they were followed up once a week for 1 month. RESULTS: None of the patients presented with infections or loss of the dermis. When the silicon sheet was detached, granulation tissue was detected, with complete re-epithelialization of the lesion in the postoperative weeks 3 to 4. CONCLUSIONS: The use of the Integra allowed for the rapid reconstruction of slight intraoral defects while preventing the morbidity associated with classic techniques. In this study, no complications were observed.