Oromandibular reconstruction with the radial-forearm osteocutaneous flap: Experience with 60 consecutive cases

One of the more difficult problems in reconstructive surgery of the head an d neck is replacement of bone and soft tissue lost because of injury, osteo myelitis, or malignancy. The radial-forearm osteocutaneous nap is an accept ed choice for oromandibular reconstruction. This study was undertaken to re view one center's experience with 60 consecutive cases of oromandibular rec onstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, nap failure rate, recipient- an d donor-site complications, length of surgery, and hospital stay. Cancer re section was the reason for 97 percent of reconstructions; 33 percent of fla ps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Me an skin flap size was 55 cm(2) (range, 15 to 117 cm(2)) and mean bone lengt h, 9.4 cm (range, 5 to 14 cm). The microvascular success rate tvas 98.3 per cent. Complications included fracture of the donor radius (15 percent), non union of the mandible (5 percent), and hematoma (8.3 percent). These result s are comparable to results reported in the literature with other radial fo rearm flaps. The free radial osteocutaneous flap is a safe and reliable cho ice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomos is to the contralateral side of the neck. The above attributes make the rad ial forearm osteocutaneous flap one of the "first line" flap choices for or omandibular reconstruction.