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Oleg N. Militsakh, MD; Andreas Werle, MD; Nadia Mohyuddin, MD; E. Bruce Toby, MD; J. David Kriet, MD; Derrick I. Wallace, MD; Douglas A. Girod, MD; Terance T. Tsue, MD

Arch Otolaryngol Head Neck Surg. 2005;131:571-575.

Objective  To compare our experience with the osteocutaneous radial forearm free flap (group 1) (n = 108) with other commonly used osteocutaneous free flaps (group 2) (n = 56) such as the fibula and scapula in single-stage oromandibular reconstruction.

Design  Retrospective case review.

Setting  Tertiary-care academic medical center.

Patients  One hundred sixty-three consecutive patients who underwent 164 mandibular reconstructions with osteocutaneous free flaps.

Main Outcome Measures  Assessment of preoperative and intraoperative variables for both groups. We compared recipient-site complication rate, intensive care unit stay, total hospital stay, and postoperative function.

Results  The most common donor site used was the radius (n = 108 [66%]), followed by the fibula (n = 36 [22%]) and scapula (n = 20 [12%]). Mean follow-up was 29 months (range, 1-116 months). Group 2 patients had larger soft tissue and/or bony defects. Surgical and medical complication rates and major donor site morbidity in group 1 were similar or better when compared with those in group 2. The lengths of the intensive care unit (4 vs 7 days; P = .009) and hospital stays (13 vs 15 days; P = .06) were shorter in group 1. Although the microvascular success rate was similar in both groups, the local wound complication rate was significantly better for group 1. The difference for the length of intensive care unit stay was statistically significant and potentially amounts to more than $6000 of savings. Functional outcomes, including the ability to tolerate oral diet, tracheostomy presence, and dental rehabilitation, were similar between the groups.

Conclusions  The primary site long-term morbidity, donor site morbidity, and postoperative function of osteocutaneous radial forearm free flaps are comparable to those of other commonly used osteocutaneous free flaps such as the fibula and scapula when used in single-stage oromandibular reconstruction.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Militsakh, Kriet, Wallace, Girod, and Tsue) and Orthopedics (Dr Toby), University of Kansas School of Medicine, Kansas City; Department of Pediatric Otolaryngology, Texas Children’s Hospital, Houston (Dr Werle); and Department of Otolaryngology–Head and Neck Surgery, University of Illinois–Chicago (Dr Mohyuddin).

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