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CC BY-NC 4.0 · Arch Plast Surg 2018; 45(06): 495-503
DOI: 10.5999/aps.2017.01592
Review Article

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

Marie Kearns
1Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry, London, UK
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
,
Panagiotis Ermogenous
1Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry, London, UK
Department of Plastic and Reconstructive Surgery and Burns Unit, Nicosia General Hospital, Nicosia, Cyprus
,
Simon Myers
1Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry, London, UK
,
Ali Mahmoud Ghanem
1Academic Plastic Surgery, Barts and the London School of Medicine and Dentistry, London, UK
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With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

Keywords

Free tissue flaps - Mandibular reconstruction - Quality of life - Postoperative complications


Publication History

Received: 17 October 2017

Accepted: 15 March 2018

Article published online:
03 April 2022

© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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