Fibula and Osteocutaneous Radial Forearm Free Flap Are Comparable

Does the osteocutaneous radial forearm free flap (OCRFFF) provide equivalent functional outcomes and improved morbidity compared to the fibular free flap (FFF) in mandibular reconstruction?

Background: Although widely used due to length and quality of bone, FFF routinely results in up to three months of antalgic gait and can cripple the elderly population. Recently there has been an increase in the use of OCRFFF.

Study Design: Retrospective review between January 2001 and December 2008 of 117 FFF patients and 51 OCRFFF patients

Setting: University of Alabama, Birmingham

Synopsis: Comparable functional outcomes were demonstrated after OCRFFF and FFF. An oral diet was tolerated in 72.6 percent of FFF and 79.1 percent of OCRFFF patients. An enterogastric feeding tube was retained in 27.4 percent of the FFF patients and 20.9 percent of the OCRFFF patients. There was no difference in length of hospital stay, and median survival rates were comparable. Early complications were seen in 17.9 percent of FFF and 25.5 percent of OCRFFF patients, with skin paddle necrosis requiring additional flap coverage the most common. Late complications were seen in 11.9 percent of FFF patients and 13.7 percent of OCRFFF patients, with malunion the most common, followed by infection. In general, older patients tended to receive OCRFFF due to concerns about prolonged difficulty with walking.

Bottom Line: Where appropriate for the defect, osteocutaneous radial forearm free flaps provide comparable functional outcomes to fibular free flap reconstruction.

Citation: Virgin FW, Iseli TA, Iseli CE, et al. Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects. Laryngoscope. 2010;120(4):663-667.

—Reviewed by Sue Pondrom