Use of the Radial Vessel Stump in Free Radial Forearm Flaps as a Flap Monitor in Head and Neck Reconstruction

The versatile use of the free radial forearm flap for the reconstruction of pharyngoesophageal defects has been proven to be ideal in previous studies. However, how to monitor its viability when buried underneath the skin in head and neck surgery still posed technical difficulties. A new method for buried free radial forearm flap monitoring was presented.

Eighteen patients received free radial forearm flap reconstructions for their pharyngoesophageal defects after tumor ablation during the period from June 2003 to March 2005. All patients were males with ages ranging from 36 to 71 years, averaging 53.2 years old. Fourteen skin tubes and four patches were designed for the defects. The pharyngoesophageal defects ranged from 6 to 12 cm, averaging 8.5 cm. The distal end of the radial vessel stump on the free radial forearm flap was elevated above the skin in the neck region to act as a monitor for the viability of the buried flap.

All free flap transfer was successful. Radial vessel stump monitoring was used for the early detection of compromised pedicles, by direct observation of the pulsatile radial vessel stump. One case of flap venous thrombosis was detected and the flap was salvaged by venous re–anastomosis. Two cases of orocutaneous fistula, 1 case of pharyngocutaneous fistula, and 1 case of esophagocutaneous fistula were noted. Three cases of wound infection recovered after antibiotic treatment.

This radial vessel stump monitoring method allows easy interpretation of flap vessel patency by the nursing staff, without the need for rigorous training, and no further aesthetic compromise of the donor site is necessary for elevation of this particular radial stump.