OROMANDIBULAR RECONSTRUCTION USING A KEEL-SHAPED MODIFICATION OF THE RADIAL FOREARM OSTEOCUTANEOUS FLAP

The keel-shaped modification for harvest of the radial forearm osteocu taneous flap has been used to reconstruct 19 oromandibular defects in 18 patients. Fourteen men and 4 women ranging in age from 22 to 27 yea rs have undergone composite mandibular reconstruction, with follow-up ranging from 3 to 36 months. Sixteen patients (17 reconstructions) had resection of advanced malignancies, and 2 patients sustained shotgun wounds. Twelve symphyseal and 7 lateral or posterior defects were reco nstructed with donor radius bone ranging in length from 5 to 13.5 cm. Double osteotomies were performed in 7 patients. Two skin paddles were used in 4 patients to provide simultaneous intraoral lining and exter nal skin coverage. The radial forearm osteocutaneous flap is still an excellent choice for oromandibular reconstruction. Anterior and latera l composite mandibular defects were satisfactorily reconstructed both aesthetically and functionally using the keel-shaped modification of t he radial forearm flap. Donor-site problems were uncommon and minor, a nd long-term forearm function was minimally affected. Radius fracture occurred in only 1 patient.