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A technique to stabilize the radius after harvesting osteocutaneous flaps
A technique to stabilize the radius after harvesting osteocutaneous flaps V. Ilankovan, B. S. Avery, G. Putnam Depurtment ~f’Muxillofacia1 Surgery, Middlesborough Generul Hospital, Middlesborough; Muxillofacial Surgery, Poole Ilospitul NHS Trust, Poole, Dorset
SUMMARY posite flap.
Department
qf
A new technique is described which improves the stability of the radius after harvesting a com-
lNTRODUCTION Composite radial forearm free flap with skin, fascia and part of the radius is a standard reconstructive technique to cover intra oral bony defects. The majority of the patients are elderly and they require resection. after tumour reconstruction Postoperatively, the donor site is usually supported in a plaster cast with the arm placed in a functional position. In spite of this, fracture of the distal end of the radius occured in 30% of the patients according to two different studies.‘.’ WC describe a technique based on rigid internal fixation to enhance rigidity of the radius and possibly reduce the incidence of fracture. MJXTHOD Subsequent to harvesting the composite graft, the wrist joint is flexed to almost 90” and a longitudinal stab incision is made at Listcr’s tuberclc. The distal
Fig. 2 - Anteroposterior and lateral radiograph of left forearm with Rush nail in position after harvesting an osteocutancous composite flap. (The missing finger was lost in a previous accident).
end of the radius is exposed by blunt dissection between the tendons of the extensor carpi radialis longus and extensor pollicis longus. A 5 mm diameter Rush nail of suitable length (Manufacturer: Howmedica International Ltd) is selected and inserted at the distal end of radius. The nail is advanced under hand pressure through the medullary cavity across the defect into the proximal portion of the intact radius. The proximal extension should bc at least 2 inches into the medulla. The curved end of the nail lies subcutaneously and the stab wound is closed primarily. The nail can be removed under local anacsthetic after radiographic evidence of healing which may take up to 3-5 months. DISCUSSION
Fig. I - Anteroposterior
and lateral
radiograph
The radius has a slight longitudinal technique works on the principle
of left forearm 50
curve and this of three point
A technique
fixation. It is comfortable to the patient post operatively and the wrist movement is not grossly hindered. It is also possible to inspect the wound and the skin graft during the healing period because there is no plaster cast. The early results are encouraging and we have commenced a prospective study to evaluate the compressivc and tensile strengths of the radius before and after harvesting bone and also with Rush nail in situ.
to stabilize
the radius
after
harvesting
osteocutaneous
Haps
The Authors V. Ilankuvan FDS RCS FRCS B. S. Avery FDS RCS FRCS G. Putnam FDS RCS FRCS Department of Maxillofacial Surgery Middlesborough General Hospital Middlesborough
References
Correspondence and requests Department of Maxillofacial Longfleet Road, Poole BHl5
I. Boorman JG, Brown JA, Sykes PJ. Morbidity in the forearm flap donor arm. Br J Plas Surg 1987; 40: 207 212. 2. Vaughan ED. The radial forearm free flap in orofacial reconstruction. .I Craniomaxillofac Surg 1990: 18: 207.
Paper received 8 April 1YY3 Accepted 22 July 1993
for offprints to Mr V. Ilankovan, Surgery, Poole Hospital NHS Trust, 2JB. Dorset
51
SUMMARY posite flap.
Department
qf
A new technique is described which improves the stability of the radius after harvesting a com-
lNTRODUCTION Composite radial forearm free flap with skin, fascia and part of the radius is a standard reconstructive technique to cover intra oral bony defects. The majority of the patients are elderly and they require resection. after tumour reconstruction Postoperatively, the donor site is usually supported in a plaster cast with the arm placed in a functional position. In spite of this, fracture of the distal end of the radius occured in 30% of the patients according to two different studies.‘.’ WC describe a technique based on rigid internal fixation to enhance rigidity of the radius and possibly reduce the incidence of fracture. MJXTHOD Subsequent to harvesting the composite graft, the wrist joint is flexed to almost 90” and a longitudinal stab incision is made at Listcr’s tuberclc. The distal
Fig. 2 - Anteroposterior and lateral radiograph of left forearm with Rush nail in position after harvesting an osteocutancous composite flap. (The missing finger was lost in a previous accident).
end of the radius is exposed by blunt dissection between the tendons of the extensor carpi radialis longus and extensor pollicis longus. A 5 mm diameter Rush nail of suitable length (Manufacturer: Howmedica International Ltd) is selected and inserted at the distal end of radius. The nail is advanced under hand pressure through the medullary cavity across the defect into the proximal portion of the intact radius. The proximal extension should bc at least 2 inches into the medulla. The curved end of the nail lies subcutaneously and the stab wound is closed primarily. The nail can be removed under local anacsthetic after radiographic evidence of healing which may take up to 3-5 months. DISCUSSION
Fig. I - Anteroposterior
and lateral
radiograph
The radius has a slight longitudinal technique works on the principle
of left forearm 50
curve and this of three point
A technique
fixation. It is comfortable to the patient post operatively and the wrist movement is not grossly hindered. It is also possible to inspect the wound and the skin graft during the healing period because there is no plaster cast. The early results are encouraging and we have commenced a prospective study to evaluate the compressivc and tensile strengths of the radius before and after harvesting bone and also with Rush nail in situ.
to stabilize
the radius
after
harvesting
osteocutaneous
Haps
The Authors V. Ilankuvan FDS RCS FRCS B. S. Avery FDS RCS FRCS G. Putnam FDS RCS FRCS Department of Maxillofacial Surgery Middlesborough General Hospital Middlesborough
References
Correspondence and requests Department of Maxillofacial Longfleet Road, Poole BHl5
I. Boorman JG, Brown JA, Sykes PJ. Morbidity in the forearm flap donor arm. Br J Plas Surg 1987; 40: 207 212. 2. Vaughan ED. The radial forearm free flap in orofacial reconstruction. .I Craniomaxillofac Surg 1990: 18: 207.
Paper received 8 April 1YY3 Accepted 22 July 1993
for offprints to Mr V. Ilankovan, Surgery, Poole Hospital NHS Trust, 2JB. Dorset
51