Reconstruction with Radial Forearm Free Flap after Ablative Surgery for Oral Cavity and Oropharyngeal Cancers

구강암과 구인두암의 절제술 후 전완유리피판술을 이용한 재건술

  • Cho Kwang-Jae (Department of Otolaryngology-HNS, The Catholic University of Korea College of Medicine) ;
  • Chun Byung-Jun (Department of Otolaryngology-HNS, The Catholic University of Korea College of Medicine) ;
  • Sun Dong-Il (Department of Otolaryngology-HNS, The Catholic University of Korea College of Medicine) ;
  • Cho Seung-Ho (Department of Otolaryngology-HNS, The Catholic University of Korea College of Medicine) ;
  • Kim Mn-Sik (Department of Otolaryngology-HNS, The Catholic University of Korea College of Medicine)
  • 조광재 (가톨릭대학교 의과대학 이비인후과학교실) ;
  • 천병준 (가톨릭대학교 의과대학 이비인후과학교실) ;
  • 선동일 (가톨릭대학교 의과대학 이비인후과학교실) ;
  • 조승호 (가톨릭대학교 의과대학 이비인후과학교실) ;
  • 김민식 (가톨릭대학교 의과대학 이비인후과학교실)
  • Published : 2003.05.01

Abstract

Background and Objectives: Surgical ablation of tumors in the oral cavity and the oropharynx results in a three dimensional defect because of the needs to resect the adjacent area for the surgical margin. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for this defect, which offers a thin, pliable, and relatively hairless skin and a long vascular pedicle. We report the clinical results of our 54 consecutive radial forearm free flaps used for oral cavity and oropharynx cancers. Materials and Methods: We reviewed the medical records of patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for oral cavity and oropharyngeal cancers from August 1994 to February 2003 and analyzed surgical methods, flap survival rate, complication, and functional results. Among these, 20 cases were examined with modified barium swallow to evaluate postoperative swallowing function and other 8 cases with articulation and resonance test for speech. We examined recovery of sensation with two-point discrimination test in 15 cases who were offered sensate flaps. Results: The primary sites were as follows : mobile tongue (18), tonsil (17), floor of mouth (4), base of tongue (2), soft palate (2), retromolar trigone (3), buccal mucosa (1), oro-hypopharynx (6), and lower lip (1). The paddles of flaps were tailored in multilobed designs from oval shape to tetralobed design and in variable size according to the defects after ablation. This procedures resulted in satisfactory flap success rate (96.3%) and showed good swallowing function and social speech. Eight of 15 cases (53.3%) who had offered sensate flap showed recovery of sensation between 1 and 6 postoperative months (average 2.6 month). Conclusion: The reconstruction with radial forearm free flap might be an excellent method for the maximal functional results after ablative surgery of oral cavity and oropharyngeal cancers that results in multidimensional defect.

Keywords

References

  1. Ariyan S : Further experiences with the pectoralis myocutaneous flap for the immediate repair of defects from excisions of head and neck cancers. Plast Reconstr Surg. 1979 ; 64 : 605-612 https://doi.org/10.1097/00006534-197964050-00002
  2. Biller HF, Baek SM, Lawson W, Krespi YP, Blaugrnnd SM : Pectoralis major myocutaneous island flap in head and neck surgery : analysis of complications in 42 cases. Arch Otolarygol. 1981 : 107 : 23-26
  3. Schuller DE : Limitations of the pectoralis major myocutaneous flap in head and neck cancer reconstruction. Arch Otolaryngol. 1980 ; 106 : 709-714 https://doi.org/10.1001/archotol.1980.00790350051013
  4. Muldowney JB, Cohen JI, Porto DP, Maisel RH : Oral cavity reconstruction using the free radial forearm flap. Arch Otolaryngol. 1987 ; 113 : 1219-1224 https://doi.org/10.1001/archotol.1987.01860110085013
  5. Sadove RC, Luce EA, McGrath PC : Reconstruction of the lower lip and chin with the composite radial forearm-palmaris longus free flap. Plast Reconstr Surg. 1991 ; 88 : 209-214 https://doi.org/10.1097/00006534-199108000-00005
  6. Logemann JA : Role of the modified barium swallow in management of patients with dysphagia. Otolaryngol Head Neck Surg. 1997 ;116 : 335-338 https://doi.org/10.1016/S0194-5998(97)70269-9
  7. Schriberg L, Kwiatkowski J : A procedure for assessing severity and hearing disorders. Phonological disorders. 1982 ; 47 : 256-270
  8. Bzoch KR, Trost JE : Clinical assessment, evaluation, and management of categorical aspects of cleft palate speech disorders. Communicative disorders related of cleft lip and palate. Austin, Texas: Proed. 1997
  9. Kim MS, Lee DJ, Cho SH, Suh BD : Reconstruction of the tongue with free flap after total glossectomy. Korean J Otolaryngol. 1996 ; 39 : 1890-1897
  10. Choi EC : Design of pectoralis major myocutaneous flap for reconstruction of the tonsillar area. Korean J Otolaryngol. 1995 ; 38: 454-458
  11. Haughey BH : Tongue reconstruction : Concepts and practice. Laryngoscope. 1983 ; 103 : 1132-1141
  12. Hayden RE : Lateral thigh flap. Otolaryngol Clin North Am. 1994 ; 27 : 1171-1183
  13. Soutar DS, McGregor IA : The radial forearm flap in intraoral reconstruction : The experience of 60 consecutive cases. Plast Reconstr Surg. 1986 ;78 : 1-8 https://doi.org/10.1097/00006534-198607000-00001
  14. Uken ML, Biller HF : A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy. Arch Otolaryngol Head Neck Surg. 1994 ; 120 : 26-31 https://doi.org/10.1001/archotol.1994.01880250022002
  15. Brown JS, Zuydam AC, Jones DC, Rogers SN, Vaughan ED : Functional outcome in soft palate reconstruction using a radial forearm free jlap in conjunction with a superiorly based pharyngealjlap. Head Neck. 1997 ; 19 : 524-534 https://doi.org/10.1002/(SICI)1097-0347(199709)19:6<524::AID-HED10>3.0.CO;2-5
  16. Logemann JA, Bytell DE : Swallowing disorders in three types head and neck surgical patients. Cancer. 1979 ; 44 : 1095-1105 https://doi.org/10.1002/1097-0142(197909)44:3<1095::AID-CNCR2820440344>3.0.CO;2-C
  17. Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ : Effect of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg. 1994 ; 110 : 222-227 https://doi.org/10.1177/019459989411000212
  18. Urken ML : The restoration or preservation of sensation in the oral cavity following ablative surgery. Arch Otolaryngol. 1995 ; 121 : 607-612 https://doi.org/10.1001/archotol.1995.01890060005001