Free Chimeric Designed Radial Forearm Flap with a Partial Brachioradialis Muscle for Mouth Floor Obliteration in Head and Neck Cancer Reconstruction

Background: The free radial forearm flap has been a workhorse flap in reconstruction for patients with head and neck cancer for many years. The radial forearm flap has the characteristics of thinness and pliability, which make it a proper choice for reconstruction of intra-oral defect. Leakage has been a troublesome concern when dealing with defects involving the mouth floor with the radial forearm flap due to lack of bulk.

Aim and objectives: We here present our experience using a chimeric radial forearm flap with the brachioradialis muscle in head and neck cancer reconstruction, aiming to reduce complications related to leakage.

Materials and methods: Between 2012/12/1 to 2016/11/30, 82 patients underwent reconstructive surgery with a free radial forearm flap. Among these patients, 10 were treated with a chimeric radial forearm flap and 72 patients were treated with a non-chimeric designed radial forearm flap. Among the chimeric flap group, 1 patient with the diagnosis of hypopharyngeal cancer was excluded due to lack of mouth floor defect (the brachioradialis muscle was used as a monitor flap in this case). We reviewed patients' basic data, peri-and post-operative condition, flap survival, and post-operative course of the 9 patients treated with a chimeric radial forearm flap. We also compared the operative time of these 9 patients with those of the remaining 72 patients treated with a non-chimeric designed radial forearm free flap.

Results: In the chimeric flap group, the muscle part of the chimeric flap was used to obliterate a mouth floor defect. Total flap survival occurred in 7 patients, minimal flap edge necrosis in 1 patient, and total flap loss in 1 patient. 8 patients had an uneventful hospital course without any complication related to wound leakage. 1 patient experienced total flap loss due to vessel kinking. In the non-chimeric designed flap group, 7 patients experienced complications related to wound leakage with various extent during hospitalization. The mean operative times for chimeric and non-chimeric designed radial forearm flaps were not significantly different (chimeric: 329.9 mins, non-chimeric: 351.7 mins, P=0.1032). Morbidity of the donor site was limited.

Conclusion: The chimeric radial forearm and brachioradialis muscle flap is a practical and effective technique in head and neck cancer reconstruction with the advantage of reducing complications related to leakage.