Development of a Cutting Guide for Osteocutaneous Radial Forearm Free Flap Harvest

The osteocutaneous radial forearm free flap (OCRFFF) is used for the reconstruction of bony head and neck defects. Being a weight-bearing bone, precise harvesting of the radius is required to maintain structural integrity, postoperative forearm function, and to prevent postoperative fracture. A radius cutting guide may allow head and neck surgeons to be more precise and confident in performing bony harvest, and may improve allocation of orthopedic specialist resources.

A custom radius cutting guide was developed in an iterative process with six head and neck surgeons and one hand surgeon. Following design approval, a prospective feasibility study was conducted. Patient-specific cutting guides were created using pre-operative upper-extremity computed tomography (CT) scans. The length and cross-sectional width of harvested radius bone were measured. The length of time using the guide was recorded. Providers were surveyed to assess their perception of cutting guide utility.

A total of eight patients were enrolled, and the cutting guide was used successfully in seven patients. The mean length of the radius harvested was 77.1 ± 13.8 mm. The mean cross-sectional width of the radius planned for harvest was 11.7 ± 1.7 mm. The mean width of the bone harvested was 12.1 ± 1.2 mm, with a mean difference of + 0.81 mm. The mean total time using the guide was 12.94 min (range 10.0-20.1 min). Survey respondents (n = 7) agreed that the guide did not interfere with their ability to harvest radius bone (mean response 9.0 ± 1.3) and that they would utilize the guide in practice (9.4 ± 1.1).

Patient-specific cutting guides for OCRFFF harvest are feasible and may improve head and neck reconstructive surgeons' comfort with harvest.