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Single Stage Reconstruction of Composite Rhinectomy Defects Using Osteocutaneous Radial Forearm Free Flap.

Head Neck

December 2024

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.

Background: Composite rhinectomy defects pose significant challenges due to the nose's complex structure and role in facial esthetics and function. Traditional nasal reconstructions often require multiple stages to restore mucosal lining, structural support, and external skin.

Methods: This case series examines the use of a single-stage osteocutaneous radial forearm free flap (OCRFFF) for composite rhinectomy reconstruction.

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 End-to-side (ES) venous anastomosis is an established approach for head and neck reconstruction and has several benefits over conventional end-to-end (EE) anastomosis. However, this is not preferred by all, which may be due to technical preferences for an EE anastomosis by many surgeons. We present here our experience of routine ES venous anastomosis for head and neck reconstruction over the past 8 years.

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Background: This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN).

Methods: Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis.

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Background: Microvascular free-tissue transfer is a widely used technique for surgical site reconstruction following head and neck mass resection. While it is commonly used in adults, the rarity of head and neck cancers in children makes free flap reconstruction relatively rare in this population. Free flap reconstruction allows for coverage of large defects which may result from wide resections performed to avoid exposing pediatric patients to primary radiotherapy.

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The osteocutaneous radial forearm (OCRFF) is a versatile free flap option for bony defects of the head and neck, given the thinness and pliability of the forearm cutaneous paddle, pedicle length, reliability, lack of atherosclerosis, and functional concerns common to other osseous donor sites. The OCRFF was once associated with a high risk of radial fracture, in addition to concerns about the quality and durability of bone stock for osseous reconstruction, particularly for the mandible. Following the introduction of prophylactic plating of the radius, the incidence of symptomatic radial fracture has drastically decreased.

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