Morbidity of the Radial Forearm Flap: A calculable Risk?

Introduction:

The radial forearm flap (RFF) is the workhorse in the reconstructive head and neck surgery. Although, there is a donor site morbidity (DSM) and recipient side morbidity (RSM). The aim of this study is the evaluation of donor side and recipient side complications.

Methods:

We analyzed retrospectively all patients that underwent surgery with an RFF from 2012 to 2016 in our hospital.

Results:

We included 95 patients. The RFF with its vascular pedicle is harvested with an additional pedicle of the cephalic vein. All microsurgical anastomoses were done by a simple interrupted suture technique. The artery was anastomoses in 88 times to the superior thyroid artery, 3 times to the facial artery, 2 times to lingual artery, 1 time to the external carotid artery, 1 time to the transverse cervical artery. In 90 patients, we anastomosed 3 veins (2 venae comitantes+1 cephalic vein), in 5 patients, we anastomosed 2 veins (1 vena comitans+1 cephalic vein). All patients received 5000 IE heparin subcutaneously during surgery. Anticoagulation was continued 10 days after surgery. The donor side defect required a full-thickness skin graft in 71 patients, a split-thickness skin graft in 24 patients. We had complications in 28% of the patients. We had no thrombosis in any anastomoses, but flap necrosis occurred in 2 patients (2%). Revision surgery because of hematoma was done in 10 patients, 6 patients showed wound healing deficits in the circumference of the RFF, 6 patients showed wound healing deficits at the donor site, 5 patients had further small complications.

Conclusion:

Flap necrosis can be reduced by 3 venous anastomoses and early revision surgery in case of cervical hematoma. The reduction of donor side morbidity should be focused on in the future.

Publication History

Publication Date:
18 April 2018 (online)