Development of a Cutting Guide for Osteocutaneous Radial Forearm Free Flap Harvest

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-04-09 DOI:10.1002/lary.32117

Carly Fassler, Michael C. Topf, Alexis Miller, Whitney Jin, Juan M. Colazo, Lauren Luther, Douglas Weikert, Kyle Mannion, Alexander J. Langerman, Robert Sinard, Eben Rosenthal, Sarah Rohde

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Abstract

Objectives

The osteocutaneous radial forearm free flap (OCRFFF) is used for the reconstruction of bony head and neck defects. Being a weight-bearing bone, precise harvesting of the radius is required to maintain structural integrity, postoperative forearm function, and to prevent postoperative fracture. A radius cutting guide may allow head and neck surgeons to be more precise and confident in performing bony harvest, and may improve allocation of orthopedic specialist resources.

Methods

A custom radius cutting guide was developed in an iterative process with six head and neck surgeons and one hand surgeon. Following design approval, a prospective feasibility study was conducted. Patient-specific cutting guides were created using pre-operative upper-extremity computed tomography (CT) scans. The length and cross-sectional width of harvested radius bone were measured. The length of time using the guide was recorded. Providers were surveyed to assess their perception of cutting guide utility.

Results

A total of eight patients were enrolled, and the cutting guide was used successfully in seven patients. The mean length of the radius harvested was 77.1 ± 13.8 mm. The mean cross-sectional width of the radius planned for harvest was 11.7 ± 1.7 mm. The mean width of the bone harvested was 12.1 ± 1.2 mm, with a mean difference of + 0.81 mm. The mean total time using the guide was 12.94 min (range 10.0–20.1 min). Survey respondents (n = 7) agreed that the guide did not interfere with their ability to harvest radius bone (mean response 9.0 ± 1.3) and that they would utilize the guide in practice (9.4 ± 1.1).

Conclusions

Patient-specific cutting guides for OCRFFF harvest are feasible and may improve head and neck reconstructive surgeons' comfort with harvest.

Level of Evidence

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前臂桡骨皮游离皮瓣切除指南的研制。

目的：应用前臂桡骨皮游离皮瓣（OCRFFF）修复骨性头颈部缺损。桡骨作为一种承重骨，需要精确地切除以保持结构完整性、术后前臂功能和防止术后骨折。桡骨切割指南可使头颈外科医生在进行骨摘取时更加精确和自信，并可改善骨科专科资源的分配。方法：与6名头颈外科医生和1名手外科医生在迭代过程中开发了自定义半径切割导轨。设计批准后，进行了前瞻性可行性研究。使用术前上肢计算机断层扫描（CT）创建患者特异性切割指南。测量桡骨截骨长度和截骨宽度。记录使用指南的时间长度。对供应商进行了调查，以评估他们对切削导轨效用的看法。结果：共入组8例患者，其中7例患者成功使用该导切器。截骨半径平均长度为77.1±13.8 mm。计划收获半径的平均横截面宽度为11.7±1.7 mm。截骨的平均宽度为12.1±1.2 mm，平均差值为+ 0.81 mm。使用指南的平均总时间为12.94分钟（范围10.0-20.1分钟）。被调查者（n = 7）认为该导具不影响其取桡骨的能力（平均反应9.0±1.3），并表示将在实践中使用该导具（9.4±1.1）。结论：针对患者的crfff切除指南是可行的，可以提高头颈部重建外科医生的舒适度。证据等级：3；

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects