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Functional Donor Morbidity and Clinical Reliability of Radial Forearm Free Flaps in Patients with Raynauds Phenomenon
Clifford Thomas Pereira, MD; Travis Shiba, MD; Joel Sercarz, MD; Elliot Abemayor, MD; Vishad Nabili, MD; Keith Blackwell, MD; UCLA
UCLA, Los Angeles, CA, USA

Introduction:Raynaud’s phenomenon (RP) characterized by episodic vasospasm of digits triggered by cold exposure, can potentially make Radial Forearm Free Flaps (RFFFs) risky in these patients. The purpose of this study was to evaluate functional donor site morbidity and reliability of RFFFs in post-oncologic resection reconstruction in patients with RP.

Method:An Institutional Review Board approval was obtained prior to commencement of study. A retrospective chart review was conducted of all patients with RP admitted to our institute for RFFF reconstruction, from 1995 to 2012. Of a total of 516 RFFFs performed 6 patients met the above criteria. All reconstructions were performed for head and neck cancer resections. All patients had negative Allen’s tests and the non-dominant side was used in all cases. Data collected included patient demographics, tumor staging, pathology, intra and post-operative complications. Additionally a telephonic Disability of Arm, Shoulder and Hand (DASH) questionnaire was conducted on an average of 5.5 years post-operatively for the donor arm. Data was analyzed using Microsoft Office Excel 2007

Results:Mean age was 66 years with a female predominance (66.7%). The primary pathology was squamous cell carcinoma in all patients. Two of the six patients had Primary RP, and the rest were secondary to rheumatoid arthritis (3 patients) and scleroderma (one patient). Fifty percent patients had had previous neck irradiation and fifty percent were on prednisolone and one disease modifying agent at the time of surgery. Tourniquet time was 81±22 minutes and flap ischemia time was 148±23 minutes. All flaps had one arterial and one venous anastomosis except one flap which required a second venous anastomosis (at the time of surgery) to improve out-flow. None of the flaps had any microvascular complications. DASH scores were consistently below 4 indicating a low disability. None of the patients reported a worsening of their RP in the immediate or late post-operative period.

Conclusion:RP can be perceived as a potentially high-risk factor for free tissue transfer in Head and Neck cancer patients, both for donor site morbidity (i.e. worsening RP in donor hand) and recipient reliability (i.e. microvascular compromise from vascular instability). Added risk factors in these patients include preoperative radiation and concurrent immunosuppressive therapy. Our series indicates no increased risk of thrombosis at recipient site or worsening of function in donor hand as long as Allen’s test is negative. In conclusion this patient population should not be precluded from free flap reconstruction.

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