The osteocutaneous radial forearm free flap: A multidisciplinary review of the evidence

Janice L Farlow; Hilary C McCrary; Molly Meeker; John Alexander; Catherine T Haring; Matthew O Old; Stephen Y Kang; Sarah L Rohde; Nolan B Seim

doi:10.1016/j.oraloncology.2024.106925

The osteocutaneous radial forearm free flap: A multidisciplinary review of the evidence

Oral Oncol. 2024 Oct:157:106925. doi: 10.1016/j.oraloncology.2024.106925. Epub 2024 Jul 17.

Authors

Janice L Farlow¹, Hilary C McCrary², Molly Meeker³, John Alexander⁴, Catherine T Haring⁵, Matthew O Old⁵, Stephen Y Kang⁵, Sarah L Rohde⁶, Nolan B Seim⁷

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA.
² Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
³ College of Medicine, The Ohio State University, Columbus, OH, USA.
⁴ Department of Orthopaedics, The Ohio State University, Columbus, OH, USA.
⁵ Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.
⁶ Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA. Electronic address: [email protected].

PMID: 39024698
DOI: 10.1016/j.oraloncology.2024.106925

Abstract

The osteocutaneous radial forearm (OCRFF) is a versatile free flap option for bony defects of the head and neck, given the thinness and pliability of the forearm cutaneous paddle, pedicle length, reliability, lack of atherosclerosis, and functional concerns common to other osseous donor sites. The OCRFF was once associated with a high risk of radial fracture, in addition to concerns about the quality and durability of bone stock for osseous reconstruction, particularly for the mandible. Following the introduction of prophylactic plating of the radius, the incidence of symptomatic radial fracture has drastically decreased. Furthermore, modifications of the bony osteotomies and other evolutions of this flap harvest have increased the use of the OCRFF throughout the head and neck. Despite these advantages, the OCRFF is not widely utilized by microvascular reconstructive surgeons due to perceived limitations and risks. Herein, we present a multidisciplinary, contemporary review of the harvest technique, outcomes, and perioperative management for the OCRFF.

Keywords: Cohort studies; Free tissue; Head and neck neoplasms / surgery; Human; Microvascular reconstruction; Osseous reconstruction; Osteocutaneous radial forearm free flap; Postoperative complications; Reconstructive surgical procedures; Retrospective studies.

Publication types

Review

MeSH terms

Forearm* / surgery
Free Tissue Flaps*
Head and Neck Neoplasms / surgery
Humans
Plastic Surgery Procedures / methods
Radius / surgery