introduction methodology discussion conclusion references
SINGLE PEDICLED RADIAL ARTERY FOREARM FLAP IN THE RECONSTRUCTION OF BILATERAL SUBMUCOUS FIBROSIS RELEASE Naveen BS MDS, Moni A Kuriakose MD, FRCS, Vikram Kekatpure MS, MCh, Naveen Hedne MS, MCh, Sachin Chavre DNB, MCh; Vijay Pillai MDS, MBBS; Bichu Jacob MDS, MBBS; Athira R MS; Shubhra C MDS
INTRODUCTION Oral submucous fibrosis (OSMF) is a condition unique to our continent caused by habitual use of arecanut. It is associated with fibrous bands in buccal mucosa resulting in progressively reduced mouth opening and is precancerous in 10% . Curative intent treatment aims at the removal of fibrous mucosa and providing adequate mouth opening. Use of bilateral forearm flap to reconstruct buccal mucosal defects following trismus release though effective and reliable involves sacrifice of both radial arteries. Also bilateral free flaps are time consuming. We report a technique of harvesting two radial artery forearm flaps from single forearm donor site
METHODOLOGY
TRISMUS RELEASE
FLAP SKIN MARKINGS
FLAP DISSECTION
We report two cases where bilateral oral submucous fibrosis release and coronoidectomy was done and the defect in bilateral buccal mucosa was reconstructed with single pedicle radial artery forearm flap. Two separate flaps were designed on the same artery and concomitant vein pedicle. Distant flap was marked in the standard fashion and proximal flap was marked in the mid third of arm based on septocutaneous branches of radial artery. Bilateral buccal mucosa defects were reconstructed separately. Vascular anastomosis was done to facial vessels on one side. Both flaps survived uneventfully
DISCUSSION Literature shows many studies where bilateral free flaps from double donor sites used for the reconstruction OSMF release. Using a single pedicle radial artery forearm flap for bilateral buccal mucosa defect is a relatively novel approach. Long pedicle length ensures an anastomosis to neck vessels.
FLAP INSET
FOLLOW UP 2 MONTHS – RECIEPIENT SITE
FOLLOWUP 2 MONTHS – DONOR SITE
CONCLUSION Single pedicle radial artery forearm flap is a useful option for reconstruction of bilateral buccal defects. Donor site morbidity is minimal and limited to one forearm.
REFERENCES • Bipaddled radial forearm flap for the reconstruction of bilateral buccal mucosa defects in oral submucous fibrosis. Lee J T et al.Int J Oral maxillofac Surg, 2007 Jul;36(7):61-5 • Reconstruction of buccal mucosa following release for submucous fibrosis using two radial forearm flaps from single donor site. Tsao et al. J Plast Reconstr Aesthet Surg 2010 Jul;63 (7):1117-23.
FOLLOW UP 18 MONTHS – RECIEPIENT SITE
FOLLOWUP 18 MONTHS – DONOR SITE
INTRODUCTION Oral submucous fibrosis (OSMF) is a condition unique to our continent caused by habitual use of arecanut. It is associated with fibrous bands in buccal mucosa resulting in progressively reduced mouth opening and is precancerous in 10% . Curative intent treatment aims at the removal of fibrous mucosa and providing adequate mouth opening. Use of bilateral forearm flap to reconstruct buccal mucosal defects following trismus release though effective and reliable involves sacrifice of both radial arteries. Also bilateral free flaps are time consuming. We report a technique of harvesting two radial artery forearm flaps from single forearm donor site
METHODOLOGY
TRISMUS RELEASE
FLAP SKIN MARKINGS
FLAP DISSECTION
We report two cases where bilateral oral submucous fibrosis release and coronoidectomy was done and the defect in bilateral buccal mucosa was reconstructed with single pedicle radial artery forearm flap. Two separate flaps were designed on the same artery and concomitant vein pedicle. Distant flap was marked in the standard fashion and proximal flap was marked in the mid third of arm based on septocutaneous branches of radial artery. Bilateral buccal mucosa defects were reconstructed separately. Vascular anastomosis was done to facial vessels on one side. Both flaps survived uneventfully
DISCUSSION Literature shows many studies where bilateral free flaps from double donor sites used for the reconstruction OSMF release. Using a single pedicle radial artery forearm flap for bilateral buccal mucosa defect is a relatively novel approach. Long pedicle length ensures an anastomosis to neck vessels.
FLAP INSET
FOLLOW UP 2 MONTHS – RECIEPIENT SITE
FOLLOWUP 2 MONTHS – DONOR SITE
CONCLUSION Single pedicle radial artery forearm flap is a useful option for reconstruction of bilateral buccal defects. Donor site morbidity is minimal and limited to one forearm.
REFERENCES • Bipaddled radial forearm flap for the reconstruction of bilateral buccal mucosa defects in oral submucous fibrosis. Lee J T et al.Int J Oral maxillofac Surg, 2007 Jul;36(7):61-5 • Reconstruction of buccal mucosa following release for submucous fibrosis using two radial forearm flaps from single donor site. Tsao et al. J Plast Reconstr Aesthet Surg 2010 Jul;63 (7):1117-23.
FOLLOW UP 18 MONTHS – RECIEPIENT SITE
FOLLOWUP 18 MONTHS – DONOR SITE
