CURRENT ROLE OF THE RADIAL FOREARM FREE-FLAP IN MANDIBULAR RECONSTRUCTION

The radial forearm free flap was selected as a donor site in only 17 ( 11 percent) of 155 consecutive free flap mandible reconstructions perf ormed over a 9-year period. It was used either as an osteocutaneous fl ap (58 percent), as a soft-tissue flap alone for coverage of a reconst ruction plate (18 percent), to supplement another free flap (12 percen t), or to salvage a previous reconstruction (12 percent). The most com mon underlying disease was epidermoid carcinoma (82 percent), the aver age patient age was 55 years, and the average length of follow-up was 13.5 months. Although there was one patient death, there were no anast omotic failures. Postoperatively, two patients experienced fracture at the donor site (12 percent), and three patients (18 percent) had hard ware related problems such as exposure, infection, or both. Although e arly studies advocated using the osteocutaneous radial forearm flap as a preferred method in mandible reconstruction, superior donor site op tions such as the fibula have now relegated it to a minor role. The be st remaining indication for its use today is for a limited posterior b one defect associated with a large adjacent mucosal loss. Osseointegra ted implant capability is not important in this setting, and the short bone length needed for this application minimizes the potential for f racture at the donor site, a serious complication. Otherwise, the oste ocutaneous radial forearm flap is not recommended for the majority of segmental mandibular defects. The radial forearm flap without bone con tinues to have an important supportive role in mandibular reconstructi on. It is an excellent choice in this regard when used to cover a reco nstruction plate, as a second free flap when soft-tissue requirements are exceptionally large, or for salvage of a previous mandible reconst ruction.