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. 2023 Jun;24(3):105-110.
doi: 10.7181/acfs.2023.00171. Epub 2023 Jun 20.

Surgical outcomes of suprafascial and subfascial radial forearm free flaps in head and neck reconstruction

Sae Hwi Ki  1   2 , Tae Jun Park  1 , Jin Myung Yoon  1
Affiliations

Surgical outcomes of suprafascial and subfascial radial forearm free flaps in head and neck reconstruction

Sae Hwi Ki et al. Arch Craniofac Surg. 2023 Jun.

Abstract

Background: Conventional radial forearm free flaps (RFFFs) are known to be safe, but can result in donor site complications. Based on our experiences with suprafascial and subfascial RFFFs, we evaluated the safety of flap survival and surgical outcomes.

Methods: This was a retrospective study of head and neck reconstructions using RFFFs from 2006 to 2021. Thirty-two patients underwent procedures using either subfascial (group A) or suprafascial (group B) dissection for flap elevation. Data were collected on patient characteristics, flap size, and donor and recipient complications, and the two groups were compared.

Results: Thirteen of the 32 patients were in group A and 19 were in group B. Group A included 10 men and three women, with a mean age of 56.15 years, and group B included 16 men and three women, with a mean age of 59.11 years. The mean defect areas were 42.83 cm² and 33.32 cm², and the mean flap sizes were 50.96 cm² and 44.54 cm² in groups A and B, respectively. There were 13 donor site complications: eight (61.5%) in group A and five (26.3%) in group B. Flexor tendon exposure occurred in three patients in group A and in none in group B. All flaps survived completely. A recipient site complication occurred in two patients (15.4%) in group A and three patients (15.8%) in group B.

Conclusions: Complications and flap survival were similar between the two groups. However, tendon exposure at the donor site was less prevalent in the suprafascial group, and the treatment period was shorter. Based on our data, suprafascial RFFF is a reliable and safe procedure for reconstruction of the head and neck.

Keywords: Fascia; Free tissue flaps; Postoperative complications; Tissue donors.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Subfascial and suprafascial dissection methods of radial forearm free flaps: (A) subfascial dissection (arrow: flexor carpi radialis tendon) and (B) suprafascial dissection (arrows: remaining fascia).
Fig. 2.
Fig. 2.
(A) Partial graft loss after subfascial dissection. (B) Wellhealed donor site after suprafascial dissection.
See this image and copyright information in PMC

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