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At least 991 records · Page 55Linked to original sources
PubMed1989

[Radial forearm flap. Its versatile application in plastic surgery reconstruction of the head and neck].

The radial forearm flap is a versatile tissue transfer in the head and neck. It can be raised either from the distal or the proximal aspect of the volar forearm, and can also include the whole volar forearm skin. The flap is ideal for reconstruction of superficial defects in the head and neck, for the pharynx and oral cavity, as well as for skin defects of the face and the neck. The distal flap is thin and pliant due to the small amount of subcutaneous tissue and the fairly long vascular pedicle. A proximal flap is more bulky due to subcutaneous fat. Since the vascular pedicle of the distal flap is very long, it can also be anastomosed in the contralateral neck. Different applications and indications for the tissue transfer of the radial forearm flap are presented.

Combined Modality Therapy↗
PubMed1998

Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience.

We reviewed 109 consecutive patients with cancer of the hypopharynx or cervical oesophagus who underwent free flap transfer for immediate reconstruction after total pharyngolaryngo-oesophagectomy. The free flaps used were either free jejunal (n = 70) or radial forearm flaps (n = 39). Significantly more fistulas (3/70 compared with 15/39, p < 0.0001) and strictures (6/64 compared with 13/33, p = 0.0008) developed in the radial forearm than the jejunal flap group. However, functional donor site morbidity was minimal and there were no cases of total flap necrosis in the forearm flap group. We consider that the free jejunal flap should be the first choice for total reconstruction of pharyngo-oesophageal defects. However, the forearm flap is suitable for elderly, high risk patients, because it is less invasive and has minimal donor site morbidity, which facilitates early recovery.

Adult↗
PubMed1994

Oromandibular reconstruction using a keel-shaped modification of the radial forearm osteocutaneous flap.

The keel-shaped modification for harvest of the radial forearm osteocutaneous flap has been used to reconstruct 19 oromandibular defects in 18 patients. Fourteen men and 4 women ranging in age from 22 to 72 years have undergone composite mandibular reconstruction, with follow-up ranging from 3 to 36 months. Sixteen patients (17 reconstructions) had resection of advanced malignancies, and 2 patients sustained shotgun wounds. Twelve symphyseal and 7 lateral or posterior defects were reconstructed with donor radius bone ranging in length from 5 to 13.5 cm. Double osteotomies were performed in 7 patients. Two skin paddles were used in 4 patients to provide simultaneous intraoral lining and external skin coverage. The radial forearm osteocutaneous flap is still an excellent choice for oromandibular reconstruction. Anterior and lateral composite mandibular defects were satisfactorily reconstructed both aesthetically and functionally using the keel-shaped modification of the radial forearm flap. Donor-site problems were uncommon and minor, and long-term forearm function was minimally affected. Radius fracture occurred in only 1 patient.

Adult↗
PubMed1994

Fracture of the radial forearm osteocutaneous donor site.

Since the introduction of the osteocutaneous radial forearm flap in 1983, fractures of the radius have been reported to occur in approximately 30% of cases. Fracture of the donor forearm has been the cause of the most significant morbidity, and the difficulty in management of these fractures has been reported. We report our experience in managing three fractures involving the donor forearm. Optimum results can be achieved by early stabilization with external fixation and vascularized bone grafting. Excessive resection of the radius should be avoided and alternative sources of vascularized bone used to avoid mutilation of the forearm.

Aged↗
PubMed1996

Sharing the radial forearm flap in reconstruction of two separate defects in the same patient.

The radial forearm flap is used extensively to cover defects for which a thin skin flap is needed. It can be used either as a pedicle or a free flap in various designs. In this case report, a new application of this flap is presented in which two flaps were created out of a single radial forearm flap to cover two separate defects. One of the flaps was a distally based reverse island flap. We used this flap to cover a defect developed by releasing a burn contracture on the flexor surface of the thumb. The other flap consisted of the proximal portion of the forearm flap and was transferred to the neck region as a free flap to cover a defect resulting from the release of a burn contracture. The radial artery allows sharing the fasciocutaneous unit of the forearm into two different flaps and transferring them to separate areas. Thus, donor site morbidity is reduced when there is more than one defect to be reconstructed.

Adult↗
PubMed1996

Preexpanded radial forearm free flap to the scalp.

The radial forearm flap is a versatile tool for the reconstructive surgeon because of its thinness, durable skin quality, aesthetic match, and relative ease of dissection. This flap is an ideal candidate for reconstruction of head and neck defects. One of the drawbacks is its relative small size, which may limit its use in certain applications. We describe the preexpansion of the radial forearm flap for its use in covering a large scalp defect. Preexpansion of the radial forearm free flap enables the reconstructive surgeon to increase the size of the flap markedly without altering its neurovascular anatomic relationships. Also described is the unexpected benefit of a periprosthetic capsule that covers the flexor tendons of the forearm and acts as an excellent bed for a skin graft.

Burns↗
PubMedDate not supplied

Randomized double-blind trial of low- and moderate-dose lidocaine regional anesthesia for forearm fractures in childhood.

We undertook a randomized double-blind trial to compare the efficacy of 1.5 mg/kg body weight (low dose) and 3 mg/kg (moderate dose) lidocaine regional anesthesia for closed reductions of forearm fractures in childhood. Of the 283 children studied, 143 were randomized to the moderate-dose group and 140 to the low-dose group. The characteristics of the children and their injuries did not differ significantly. There were no complications due to lidocaine toxicity. In children with angulated and incompletely displaced fractures, satisfactory anesthesia was achieved in 94% of those receiving the low dose and in 97% of those receiving the moderate dose of lidocaine. In children with completely displaced fractures, satisfactory anesthesia was achieved in 93% of those receiving the moderate dose but in only 67% of those receiving the low dose of lidocaine. We conclude that the low-dose lidocaine protocol is suitable for children requiring closed reductions of angulated and incompletely displaced fractures of the forearm. In contrast, the moderate-dose lidocaine protocol is more reliable in children with displaced forearm fractures. Meticulous adherence to the protocols is essential to prevent systemic lidocaine toxicity from premature deflation of the tourniquet. This potential risk is further reduced by use of the low-dose protocol, which is applicable to approximately 70% of the children with forearm fractures requiring closed reductions.

Anesthesia, Local↗
PubMed1991

Immediate internal fixation of high-energy open forearm fractures.

Eighteen patients with Gustilo and Anderson Grade III A (7), III B (8) or III C (3) open diaphyseal forearm fractures were treated with a protocol consisting of extensive primary debridement, immediate open reduction, dynamic compression plate fixation, and vascular repair when indicated. This was followed by routine redebridement at 24 to 48-h intervals until wound status allowed completion of soft tissue reconstruction. Bone grafting was performed at 8 to 10 weeks following obtainment of a closed soft tissue envelope for injuries with extensive comminution or bone loss (5 patients, 7 fractures). Subsequent procedures such as tendon transfers, scar revision, joint arthrodesis, or secondary nerve reconstruction were required in 8 of 18 patients. Minor complications related to delayed wound healing occurred in 3 individuals (15%). One deep infection of a fractured radius occurred in a patient with a floating elbow and failed free flap. Salvage with debridement, retention of hardware, and a second free flap resulted in fracture union. One patient required a second bone graft to obtain union of a segmental forearm defect. Amputation was performed in one patient following failed forearm replantation with greater than 8 h warm ischemia time. Immediate debridement and plate fixation of Grade III forearm fractures performed in conjunction with aggressive soft tissue management provided good or excellent results in 12 patients (66%) and is an acceptable treatment alternative in these difficult injuries.

Adolescent↗
PubMed1995

Reduction of forearm fractures in children using axillary block anesthesia.

One hundred eleven patients (age range 15 months-16 years, mean 9.6 years) with displaced forearm fractures who had axillary blocks performed by orthopaedists in the emergency room were retrospectively reviewed. Thirty-seven fractures involved the distal radius, 56 involved both bones of the forearm, and 12 involved the physis of the distal forearm. Three Monteggia fractures, one radial neck fracture, one olecranon with an associated radial neck fracture, and one distal radius fracture with an associated elbow dislocation also were included. Of the 111 axillary blocks, 105 were rated as effective. Potential complications of axillary block anesthesia (systemic toxicity, hematoma, infection, and brachial neuralgia) were not observed in this group of patients. The cost of axillary block reduction in the emergency room was less than one third that of general anesthesia in the operating room. Axillary block anesthesia is reliable, safe, and cost effective, and this study supports its use by orthopaedists in displaced forearm fractures in children.

Adolescent↗
PubMed1999

Diaphyseal forearm fractures treated with and without bone graft.

BACKGROUND: The purpose of this study was to determine whether the acute bone grafting of diaphyseal forearm fractures decreases the incidence of nonunion and reduces the time to union. Although the traditional treatment of comminuted radius and/or ulnar shaft fractures involves bone graft, a recent report called into question this practice. PATIENTS: A database search was used to identify all acute diaphyseal forearm fractures presenting to an urban Level I trauma center between 1988 and 1996. All radius and/or ulnar shaft fractures, as well as all Monteggia and Galeazzi fracture-dislocations, in patients with closed physes were included. The charts and operative reports were available for 64 diaphyseal forearm fractures in 49 patients. Fifty-six fractures were followed for at least 1 year beyond clinical and radiographic union. The injuries were treated with open reduction and plate fixation by experienced orthopedic traumatologists. All noncomminuted fractures were treated without bone graft. For the comminuted fractures, the decision to use bone graft was left to the discretion of the operating surgeon. RESULTS: Overall, 55 of 56 fractures (98%) achieved union at a mean of 49 days (range, 19-123 days), with the only nonunion occurring in a patient with a closed, noncomminuted Galeazzi injury. Among the 20 noncomminuted fractures, all of which were treated without bone graft, 19 (95%) achieved union at a mean of 50 days (range, 19-102 days). Among the 36 comminuted fractures, all 25 treated without bone graft achieved fusion at an average of 50 days (range, 20-123 days) and all 11 treated with bone graft achieved union at an average of 45 days (range, 22-67 days). No statistically significant difference in the incidence of nonunion or time to union was noted between fractures that were treated with and without bone graft. CONCLUSION: Acute bone grafting of diaphyseal forearm fractures did not affect the union rate or the time to union.

Adult↗
PubMed1997

Current role of the radial forearm free flap in mandibular reconstruction.

The radial forearm free flap was selected as a donor site in only 17 (11 percent) of 155 consecutive free flap mandible reconstructions performed over a 9-year period. It was used either as an osteocutaneous flap (58 percent), as a soft-tissue flap alone for coverage of a reconstruction plate (18 percent), to supplement another free flap (12 percent), or to salvage a previous reconstruction (12 percent). The most common underlying disease was epidermoid carcinoma (82 percent), the average patient age was 55 years, and the average length of follow-up was 13.5 months. Although there was one patient death, there were no anastomotic failures. Postoperatively, two patients experienced fracture at the donor site (12 percent), and three patients (18 percent) had hardware related problems such as exposure, infection, or both. Although early studies advocated using the osteocutaneous radial forearm flap as a preferred method in mandible reconstruction, superior donor site options such as the fibula have now relegated it to a minor role. The best remaining indication for its use today is for a limited posterior bone defect associated with a large adjacent mucosal loss. Osseointegrated implant capability is not important in this setting, and the short bone length needed for this application minimizes the potential for fracture at the donor site, a serious complication. Otherwise, the osteocutaneous radial forearm flap is not recommended for the majority of segmental mandibular defects. The radial forearm flap without bone continues to have an important supportive role in mandibular reconstruction. It is an excellent choice in this regard when used to cover a reconstruction plate, as a second free flap when soft-tissue requirements are exceptionally large, or for salvage of a previous mandible reconstruction.

Adult↗
PubMed1999

Oromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases.

One of the more difficult problems in reconstructive surgery of the head and neck is replacement of bone and soft tissue lost because of injury, osteomyelitis, or malignancy. The radial-forearm osteocutaneous flap is an accepted choice for oromandibular reconstruction. This study was undertaken to review one center's experience with 60 consecutive cases of oromandibular reconstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, flap failure rate, recipient- and donor-site complications, length of surgery, and hospital stay. Cancer resection was the reason for 97 percent of reconstructions; 33 percent of flaps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Mean skin flap size was 55 cm2 (range, 15 to 117 cm2) and mean bone length, 9.4 cm (range, 5 to 14 cm). The microvascular success rate was 98.3 percent. Complications included fracture of the donor radius (15 percent), nonunion of the mandible (5 percent), and hematoma (8.3 percent). These results are comparable to results reported in the literature with other radial forearm flaps. The free radial osteocutaneous flap is a safe and reliable choice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomosis to the contralateral side of the neck. The above attributes make the radial forearm osteocutaneous flap one of the "first line" flap choices for oromandibular reconstruction.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

One-bone forearm procedure for partial defect of the ulna.

Two cases of partial defects of the ulna in the growing child were successfully treated with the one-bone forearm procedure and followed up for 1 and 5 years, respectively. Stable elbow and forearm could be established by synthesis of the proximal part of the ulna and the distal part of the radius. Cosmetic and functional improvement was achieved in spite of a limitation of pronation-supination in the forearm. Longitudinal growth of the affected forearm was maintained during the follow-up period after correction at surgery.

Bone Diseases, Developmental↗
PubMed1996

Forearm vascular responses to serotonin are not mediated by products of cyclooxygenase.

The involvement of cyclooxygenase-derived substances in the forearm arteriolar responses to serotonin was determined in 10 healthy male volunteers. Serotonin was infused in five incremental doses (0.003-30 micrograms min-1) for 2 min each into the brachial artery of the non-dominant forearm. Forearm blood flow (FBF) responses to each dose were measured by strain-gauge venous occlusion plethysmography. The cyclooxygenase inhibitor indomethacin (100 mg) was administered orally following the serotonin infusions. After 90 min the serotonin infusions were repeated and FBF responses measured. Serotonin caused a biphasic response with vasodilatation occurring at low doses (0.003-3 micrograms min-1, P < 0.01) and vasoconstriction occurring at the highest dose (P < 0.01). There was no significant difference in vascular response to serotonin following cyclooxygenase inhibition. In conclusion, cyclooxygenase products are not involved in the forearm vascular responses to serotonin in healthy human subjects.

Adult↗
PubMed2002

Studies of the dysglycemic peptide, pancreastatin, using a human forearm model.

The physiologic effects of the chromogranin A peptide fragment, pancreastatin, were studied in six healthy Caucasian men, ages 25-46 years. Synthetic pancreastatin (human chromogranin A(273-301)-amide) was infused into the brachial artery of each subject to achieve a local concentration of approximately 200 nM over 15 minutes. Forearm blood flow was measured by strain-gauge plethysmography while (A-V)(glucose) was monitored by arterial and venous sampling. Pancreastatin infusion significantly reduced forearm glucose uptake (mean reduction +/- 1 SEM, 54 +/- 15%; P = 0.028) but did not alter forearm blood flow-indicating a metabolic, rather than hemodynamic, effect. Simultaneous infusion of pancreastatin with insulin (0.1 mU/kg/min) did not diminish insulin-induced forearm glucose uptake, suggesting pancreastatin is not simply a negative insulin modulator. The results of this study suggest that pancreastatin may contribute to the dysglycemia associated with type 2 diabetes and essential hypertension, two common human disease states in which plasma pancreastatin levels are elevated.

Adult↗
PubMed1979

Chronic paw denervation causes an age-dependent appearance of novel responses from forearm in "paw cortex" of kittens and adult cats.

1. In normal kittens and cats, cells in a region of primary somatosensory cortex (SI) responded exclusively to input from the contralateral front paw; we called this area paw cortex (PC). A neighboring region of SI responded to input from the contralateral forearm above the wrist; we called this area forearm cortex (FC). The centers of PC and FC were about 4 mm apart. 2. In kittens several weeks after transection of the nerves to the front paw, the following changes were observed in PC: a) 52% of PC cells had receptive fields on the forearm; normally, PC cells responded to natural stimulation only of the front paw; b) many cells in PC (58%) responded to electrical stimulation of the medial cutaneous nerve from the forearm; normally, very few PC cells (9%) responded to this nerve; c) there was a 370% increase in the median amplitude of medial cutaneous-evoked potentials in PC; d) in contrast to these enhanced inputs, PC responses to ulnar nerve stimulation decreased significantly. 3. In adult cats, paw denervation initiated a similar process as in kittens, but with less marked somatotopic changes. 4. In both kittens and adults, FC was unaffected by the nerve injuries. 5. We conclude that a chronic peripheral nerve injury can produce extensive changes in SI cortex somatotopic organization; the nature of the effect is age dependent.

Age Factors↗
PubMed1980

Effects of 1 alpha-OH-D3 on bone mineral content in the forearm of chronic hemodialyzed patients.

The bone mineral content in the forearm of 99 male and 62 female patients who had never been treated with vitamin D on hemodialysis was measured to elucidate the relationship between bone mineral content and duration of hemodialysis. We found that reduction in bone mineral content related to the duration of hemodialysis in both sexes. 1--2 microgram/day of 1 alpha-OH-D3 was administered to 35 hemodialysis patients for 2 years. Bone mineral content in the forearm of both patient groups treated with and without 1 alpha-OH-D3 was measured every 3 months. Although bone mineral content in the forearm of the hemodialysis patients decreased, serum Ca, serum-ionized Ca, and serum phosphate levels increased and serum ALK-Pase and serum immunoreactive PTH decreased significantly after administration of 1 alpha-OH-D3. When bone mineral content in the forearm of patients treated with 1 alpha-OH-D3 was compared with that of untreated patients, the loss of bone mineral content in patients treated with 1 alpha-OH-D3 was less than that of the untreated group. In addition to uremic metabolic derangements, intermittently repeated humoral derangement on hemodialysis seems to cause loss of bone mineral content.

Adolescent↗
PubMed2006

Biphasic responses of the brachial artery diameter following forearm occlusion: a blunted response in the elderly.

BACKGROUND: The purpose was to examine the temporal response of the brachial artery diameter following 5 minutes of forearm occlusion in young men. A secondary objective was to compare the main features of the temporal pattern between young and old. METHODS: Sixteen young (28 +/- 8 yrs) and fifteen older (85 +/- 8 yrs) men underwent high-resolution ultrasonography of the brachial artery before and after five minutes of forearm occlusion. RESULTS: Following release of the pressure cuff the brachial artery diameter exhibits a temporal biphasic response. Initially, there is a significant reduction in brachial diameter (NIL) compared to baseline (BASE), followed by a rapid increase to a PEAK at 41 sec post release. When comparing the magnitude of the decrease in diameter and the Brachial Artery Flow Mediated Dilation (BAFMD) between Young and Old, older subjects demonstrated a blunted response (Magnitude of Decrease: Young: 2.0%; Old: 0.4%, p = 0.015, and BAFMD: Young: 7.7%; Old: 2.3%, p = 0.001). Finally, a significant relationship was noted between the magnitude of decrease and BAFMD (r = -0.44, p = 0.04). CONCLUSION: Examination of the temporal response of the brachial artery diameter following 5 minutes of forearm occlusion reveals a biphasic pattern in all participants. Specific features of this pattern are blunted in older adults compared with younger subjects. Finally, the magnitude of the drop in diameter following forearm occlusion correlates with the magnitude of the BAFMD.

Journal Article↗