Reconstructive Options for Free Radial Forearm Flap Donor Defect in Pharyngeal and Laryngeal Reconstruction
Authors: Kao-Ping Chang and Chung-Sheng Lai
Abstract: There are studies contributing alternatives to restoring the donor site of free radial forearm flap (FRFF) , indicated for reconstruction of pharyngeal and laryngeal defects, other than split thickness skin graft, such as: full thickness skin grafts, artificial dermis (Alloderm), and negative pressure wound dressing. These techniques are all aimed at establishing thin layer skin coverage. A local bilobed flap, playing a role as a second flap, is applied to cover FRFF donor site and offered as a similar soft tissue. However, the hard scar texture and secondary contracture of the skin graft cause unfavorable sequelae in hand movement and cosmetic results. Limitation of flap size and necrosis of local flaps are often occurred. To simultaneously overcome the important drawback of sacrificing the radial artery in cases of FRFF, we reported our method for restoration of radial artery in the use of anterolateral thigh (ALT) flap. The FRFF donor site is repaired in our series by the ALT, a second fasciocutaneous flap. The latter offers great and similar soft tissue coverage, which, unlike skin grafts, does not result in contracture. Also, there is neither the risk of tendon exposure nor flexor contracture. All major donor site morbidities of the FRFF were solved by the ALT flap coverage, except for abnormal sensations of the radial side of the donor hand. Therefore, the FRFF is a proper choice for pharyngeal and laryngeal defects. When it is chosen for its unique merits, the ALT flap can also serve as an alternative in reconstructing the donor site with least morbidity.