Endoscopic-Assisted Radial Forearm Free Flap Harvest: A Novel Technique to Reduce Donor Site MorbidityFunding None.
21 November 2017
12 April 2018
12 June 2018 (eFirst)
Background The radial forearm free flap (RFFF) remains a workhorse flap but can have significant donor site morbidity. The authors developed a novel technique for endoscopic-assisted RFFF (ERFFF) harvest and hypothesized improved donor site morbidity.
Methods A retrospective cohort study was conducted evaluating patients who underwent ERFFF or RFFF by a single surgeon for head and neck reconstruction between November 2011 and July 2016; outcomes and complications were compared. A telephone survey was conducted to assess patient satisfaction with donor site appearance and function.
Results Twenty-seven ERFFF and 13 RFFF harvests were performed. The cephalic vein was less commonly incorporated in ERFFF patients compared with RFFF patients (3.70 and 38.46%, respectively, p = 0.0095). ERFFF patients had lower rates of wound healing complications (0% vs. 15.38%, p = 0.10) and perfusion-related complications than RFFF patients (3.70% vs. 23.08%, p = 0.092). Fewer ERFFF patients reported a desire for a more normal appearance (42.86% vs. 71.43%, p = 0.361). The ERFFF group had a higher functional score (64.29% vs. 44.44%, p = 0.101), reporting lower rates of associated discomfort (35.71% vs. 85.71%, p = 0.063). None of the differences in rates of complications or patient-reported outcomes between the groups reached statistical significance.
Conclusion ERFFF is safe and effective alternative to RFFF, with similar operative time, similar pedicle safety, and elimination of the lengthy forearm incision. Unnecessary cephalic vein dissection can be avoided with endoscopic visualization of the venae comitantes. Further research with a larger sample size and better standardization is needed to assess effects on donor-site morbidity.
Data were published to PRSGo in an abstract format as a result of acceptance for presentation at ASPS; the manuscript has not been previously published and is not being considered for publication elsewhere.
- 1 Neligan PC. Head and neck reconstruction. Plast Reconstr Surg 2013; 131 (02) 260e-269e
- 2 Rigby MH, Taylor SM. Soft tissue reconstruction of the oral cavity: a review of current options. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (04) 311-317
- 3 Selvaggi G, Monstrey S, Hoebeke P. , et al. Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast Reconstr Surg 2006; 118 (05) 1171-1177
- 4 Richardson D, Fisher SE, Vaughan ED, Brown JS. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg 1997; 99 (01) 109-115
- 5 Zenn MR, Hidalgo DA, Cordeiro PG, Shah JP, Strong EW, Kraus DH. Current role of the radial forearm free flap in mandibular reconstruction. Plast Reconstr Surg 1997; 99 (04) 1012-1017
- 6 Seify H, Jones G, Sigurdson L. , et al. Endoscopic harvest of four muscle flaps: safe and effective techniques. Ann Plast Surg 2002; 48 (02) 173-179
- 7 Iglesias M, Gonzalez-Chapa DR. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases. Aesthetic Plast Surg 2013; 37 (04) 719-727
- 8 Lin CH, Wei FC, Levin LS, Chen MC. Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 1999; 104 (04) 1070-1077 , quiz 1078
- 9 Missana MC, Pomel C. Endoscopic latissimus dorsi flap harvesting. Am J Surg 2007; 194 (02) 164-169
- 10 Pomel C, Missana MC, Atallah D, Lasser P. Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol 2003; 29 (02) 127-131
- 11 Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg 2012; 129 (06) 1305-1312
- 12 Romanini MV, Vidal C, Godoy J, Morovic CG. Laparoscopically harvested omental flap for breast reconstruction in Poland syndrome. J Plast Reconstr Aesthet Surg 2013; 66 (11) e303-e309
- 13 Moreno MA. Video-assisted harvesting of anterolateral thigh free flap: technique validation and initial results. Otolaryngol Head Neck Surg 2013; 149 (02) 219-225
- 14 Bleiziffer S, Hettich I, Eisenhauer B. , et al. Patency rates of endoscopically harvested radial arteries one year after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2007; 134 (03) 649-656
- 15 Grus T, Lambert L, Grusová G, Rohn V, Lindner J. Endoscopic versus mini-invasive radial artery graft harvesting for purposes of aortocoronary bypass. Prague Med Rep 2011; 112 (02) 115-123
- 16 Navia JL, Brozzi N, Chiu J. , et al. Endoscopic versus open radial artery harvesting for coronary artery bypass grafting. Scand Cardiovasc J 2011; 45 (05) 279-285
- 17 Shapira OM, Eskenazi BR, Hunter CT. , et al. Endoscopic versus conventional radial artery harvest--is smaller better?. J Card Surg 2006; 21 (04) 329-335
- 18 Shapira OM, Eskenazi BR, Anter E. , et al. Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: functional and histologic assessment of the conduit. J Thorac Cardiovasc Surg 2006; 131 (02) 388-394
- 19 Frederick JW, Sweeny L, Carroll WR, Peters GE, Rosenthal EL. Outcomes in head and neck reconstruction by surgical site and donor site. Laryngoscope 2013; 123 (07) 1612-1617
- 20 Vriens JPM, Acosta R, Soutar DS, Webster MHC. Recovery of sensation in the radial forearm free flap in oral reconstruction. Plast Reconstr Surg 1996; 98 (04) 649-656
- 21 Lutz BS, Wei FC, Chang SC, Yang KH, Chen IH. Donor site morbidity after suprafascial elevation of the radial forearm flap: a prospective study in 95 consecutive cases. Plast Reconstr Surg 1999; 103 (01) 132-137
- 22 Avery C. Prospective study of the septocutaneous radial free flap and suprafascial donor site. Br J Oral Maxillofac Surg 2007; 45 (08) 611-616
- 23 Hekner DD, Abbink JH, van Es RJ, Rosenberg A, Koole R, Van Cann EM. Donor-site morbidity of the radial forearm free flap versus the ulnar forearm free flap. Plast Reconstr Surg 2013; 132 (02) 387-393
- 24 Knott PD, Seth R, Waters HH. , et al. Short-term donor site morbidity: a comparison of the anterolateral thigh and radial forearm fasciocutaneous free flaps. Head Neck 2016; 38 (Suppl. 01) E945-E948
- 25 Adani R, Rossati L, Tarallo L, Corain M. Use of Integra artificial dermis to reduce donor site morbidity after pedicle flaps in hand surgery. J Hand Surg Am 2014; 39 (11) 2228-2234
- 26 Gravvanis AI, Tsoutsos DA, Iconomou T, Gremoutis G. The use of Integra artificial dermis to minimize donor-site morbidity after suprafascial dissection of the radial forearm flap. Microsurgery 2007; 27 (07) 583-587
- 27 Murray RC, Gordin EA, Saigal K, Leventhal D, Krein H, Heffelfinger RN. Reconstruction of the radial forearm free flap donor site using Integra artificial dermis. Microsurgery 2011; 31 (02) 104-108
- 28 Rowe NM, Morris L, Delacure MD. Acellular dermal composite allografts for reconstruction of the radial forearm donor site. Ann Plast Surg 2006; 57 (03) 305-311