caa a22 4500 445334258 CHVBK 20180317142748.0 cr unu---uuuuu 170323e20110701xx s 000 0 eng 10.1245/s10434-011-1555-0 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1555-0 Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses [Elektronische Daten] [Nils Rohleder, Klaus Wolff, Frank Hölzle, Stefan Wagenpfeil, Craig Wales, Rafael Hasler, Marco Kesting] Background: The radial forearm free flap (RFFF) is commonly used in reconstructive surgery. With respect to the maxillofacial region, several venous anastomotic techniques (e.g., single or double anastomoses) have been described, but the debate as to which alternative is preferable is ongoing. A complicating factor is the unpredictable anatomical situation in patients undergoing secondary operation. No recommendations are available for the surgical strategy in such cases. We present a standard operating procedure (SOP) applicable for secondary reconstructions, postulating double anastomoses as the method of choice, and evaluate its efficacy. Methods: The following parameters were retrospectively analyzed for 120 patients with secondary (41; 34.2%) or primary (79; 65.8%) reconstruction following the instructions of SOP and compared between the study groups: age; sex; history of radiotherapy; side of the donor arm; flap size; preparation and use of the cephalic vein and reasons for its non-inclusion; included venae comitantes; recipient veins; arterial anastomoses; revisions, flap survival, and mortality within thirty days after operation. Results: The method of choice was applicable in 26 (63.4%) secondary and 52 (65.8%) primary reconstructions (no difference; P=0.841), resulting in 100% flap viability in both groups. In the remaining cases, single venous anastomoses were performed, resulting in 73.3% flap viability in secondary and 100% in primary reconstructions. Flap survival in secondary reconstructions was significantly higher when double anastomoses were conducted (P=0.012). Conclusions: The results suggest the necessity of double venous anastomoses in secondary maxillofacial reconstructions with RFFF. Society of Surgical Oncology, 2011 Rohleder Nils Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut Wolff Klaus Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut Hölzle Frank Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut Wagenpfeil Stefan Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany aut Wales Craig Department of Oral and Maxillofacial Surgery, Southern General Hospital, Glasgow, UK aut Hasler Rafael Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut Kesting Marco Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut Annals of Surgical Oncology Springer-Verlag 18/7(2011-07-01), 1980-1987 1068-9265 18:7<1980 2011 18 10434 https://doi.org/10.1245/s10434-011-1555-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1555-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Rohleder Nils Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut NATIONALLICENCE 700 1- Wolff Klaus Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut NATIONALLICENCE 700 1- Hölzle Frank Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut NATIONALLICENCE 700 1- Wagenpfeil Stefan Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany aut NATIONALLICENCE 700 1- Wales Craig Department of Oral and Maxillofacial Surgery, Southern General Hospital, Glasgow, UK aut NATIONALLICENCE 700 1- Hasler Rafael Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut NATIONALLICENCE 700 1- Kesting Marco Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/7(2011-07-01), 1980-1987 1068-9265 18:7<1980 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer