Modified Radial Forearm Free Flap And Its Application In The Immediate Reconstruction Of The Oraland Maxillofacial Defects After Malignant Tumor Ablation

Objective:Introduce glasses-shaped flap,which is a new kind of modified radial forearm free flap(MRFFF).Discuss MRFFF's indications,reliability,advantages,and technical points by comparing the postoperative function and appearance of glasses-shaped flap against the traditional radial forearm free flap(TRFFF).Methods:From January 1,2016 to December 31,2016,there are 18 cases discharging from the Department of Oral and Maxillofacial Surgery,Binjiang branch of the Second Affiliated Hospital of Zhejiang University using radial forearm free flap to reconstruct the defects of oral and maxillofacial after malignant tumor surgery,including 13 cases of glasses-shaped flap and 5 cases of traditional radial forearm free flap.Compare the survival rate,function/appearance/patient satisfaction of the oral defect area and the forearm defect area.Results:(1)The flap size of MRFFF group was from 4cm*3.5cm to 6cm*6cm,with the cephalic vein preserved and the radial artery pedicle length from 8cm to 12cm.The flap size of TRFFF group was from 4cma*5cm to 6.5cm*7cm,and the flap contained both the radial pedicle and the cephalic vein pedicle.The length of the radial pedicle was from 10cm to 14cm.(2)The cases of MRFFF group could suture the donor area directly,while the TRFFF group had to perform the free skin graft.The donor region of both MRFFF group and TRFFF group healed well after operation.(3)The survival rate of MRFFF group was 100%(13/13),and all cases used the radial artery and two accompanying veins for vascular anastomosis.The TRFFF group's survival rate was 80%(4/5),all cases used radial artery and cephalic vein for vascular anastomosis,and the case with necrosis was accompanied by plate rejection.(4)The life quality of both groups followed-up was high,while patients with MRFFF had higher satisfaction with donor site morphology.There were some cases with numbness in donor area after more than 3 months after operation:MRFFF group:4 cases with forearm numbness(4/12)and 4 cases with thumb numbness(4/12);TRFFF group:2 cases with forearm numbness(2/5)and 4 cases with thumb numbness(4/5).All the 17 patients with RFFF had little damage to forearm motor function which did not affect their daily life.Conclusions:The MRFFF can reconstruct soft tissue defects of oral and maxillofacial region as large as 6cm*6cm.The vascular anastomosis of MRFFF uses radial artery and its two accompanying veins,and the flap survival rate was 100%(13/13).MRFFF has some advantages over TRFFF:(1)It can avoid the free skin graft by suturing the donor area directly;(2)It can improve the beauty of the donor area by preserving the cephalic vein;(3)Reduce the risk of damages to the superficial and forearm lateral cutaneous nerve.