Free Radial Artery Forearm Flap for Head and Neck Reconstruction

The free radial artery forearm flap (FRAF) is a versatile and reliable reconstructive option for head and neck defects. It is based on the radial artery and its venae comitantes, which provide a well-defined vascular pedicle. The flap can be elevated as a cutaneous or fasciocutaneous flap with a skin island of up to 15 x 8 cm. The versatility of the FRAF makes it ideal for a wide range of head and neck defects, including those involving the oral cavity, oropharynx, larynx, and hypopharynx.

The FRAF is based on the radial artery, which originates from the brachial artery and runs along the radial bFree Download of the forearm. The radial artery is accompanied by two venae comitantes, which drain into the cephalic vein. The flap is innervated by the superficial radial nerve and the cutaneous branches of the ulnar nerve.

The skin of the forearm is relatively thin and pliable, making it ideal for use as a cutaneous flap. The flap can be harvested with or without the underlying fascia, depending on the needs of the reconstruction.

Free Radial Artery Forearm Flap For Head And Neck Reconstruction: A Color Atlas

by Pei-Show Juo

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Language	:	English
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The FRAF offers a number of advantages over other reconstructive options for head and neck defects. These advantages include:

• Reliability: The FRAF has a high success rate, with reported survival rates of over 95%.
• Versatility: The flap can be used to reconstruct a wide range of defects, including those involving the oral cavity, oropharynx, larynx, and hypopharynx.
• Thin and pliable: The skin of the forearm is thin and pliable, making it ideal for use in delicate areas such as the face.
• Good color and texture match: The skin of the forearm has a good color and texture match to the skin of the head and neck.
• Minimal donor site morbidity: The donor site is typically closed primarily, with minimal scarring.

The FRAF also has some disadvantages, including:

• Limited size: The flap is limited in size to approximately 15 x 8 cm.
• Radial artery harvest: The harvest of the radial artery can lead to complications such as wrist pain and weakness.
• Potential for nerve damage: The flap is innervated by the superficial radial nerve, which can be damaged during the harvest.

The FRAF is indicated for the reconstruction of a wide range of head and neck defects, including:

• Oral cavity defects: The FRAF can be used to reconstruct defects of the lips, cheeks, tongue, and floor of mouth.
• Oropharyngeal defects: The FRAF can be used to reconstruct defects of the soft palate, tonsils, and base of tongue.
• Laryngeal defects: The FRAF can be used to reconstruct defects of the supraglottis, glottis, and subglottis.
• Hypopharyngeal defects: The FRAF can be used to reconstruct defects of the pyriform sinus and posterior pharyngeal wall.

The FRAF is contraindicated in patients with:

• Active infection in the head and neck
• Poor vascularization of the forearm
• Previous radial artery harvest

The FRAF is harvested through a longitudinal incision along the radial bFree Download of the forearm. The radial artery and its venae comitantes are identified and dissected free. The flap is then elevated, either as a cutaneous or fasciocutaneous flap. The flap is inset into the defect and microvascular anastomoses are performed.

After surgery, the patient is placed on antibiotics to prevent infection. The flap is monitored closely for signs of vascular compromise. The patient is typically discharged from the hospital within 5-7 days.

Complications of the FRAF are rare, but can include:

• Flap failure: This is a rare but serious complication that can occur due to vascular compromise or infection.
• Radial artery harvest complications: These complications can include wrist pain and weakness.
• Nerve damage: This can occur during the harvest of the flap and can lead to sensory deficits in the hand.
• Donor site morbidity: This is typically minimal, but can include scarring and pain.

The FRAF is a versatile and reliable reconstructive option for head and neck defects. It has a high success rate and a low complication rate. The flap is well-suited for reconstruction of a wide range of defects, including those involving the oral cavity, oropharynx, larynx, and hypopharynx.

1. Free radial artery forearm flap for head and neck reconstruction: a systematic review and meta-analysis
2. Free radial artery forearm flap: a review of the literature
3. Free radial artery forearm flap in head and neck reconstruction: our experience

Free Radial Artery Forearm Flap For Head And Neck Reconstruction: A Color Atlas

by Pei-Show Juo

5 out of 5

Language	:	English
File size	:	73652 KB
Screen Reader	:	Supported
Print length	:	102 pages

FREE