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[Maxillofacial reconstruction with radial forearm osteofasciocutaneous free flap]
L-A See1, A de Taddéo1, B Henault1
1Service de chirurgie maxillo-faciale, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, faculté de médecine, université de Bourgogne, centre hospitalier universitaire, boulevard de Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France.
Introduction:
Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap.
Materials And Methods:
We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month.
Results:
The mean age of the 10 patients was 60.2 years. The average length of bone defect was 8 cm. The average cutaneous defect area was 36.8 cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no reconstruction failure. Three patients had mild speech disorders, five had moderate speech disorders, and two major speech disorders. Four patients had a normal food intake, three patients needed mixed food, and three patients liquid food.
Discussion:
The indications of radial forearm osteofasciocutaneous free flap for complex maxillofacial reconstructions should be extended. Its vascularization is less compromised by arteritis. Its pedicle may be long and adequate for a contralateral anastomosis. It is reliable and easy to harvest. But the bone quality is not as good as fibula.
