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Ulnar Fasciocutaneous Free Flap Favoured In Reconstructive Surgery

The ulnar fasciocutaneous free flap has all of the tissue characteristics of the radial forearm flap and should be considered when a radial forearm flap cannot be used and forearm skin is desired.

Head and neck microvascular surgeons in Portland, Oregon, noted that the radial forearm fasciocutaneous free flap had become the reconstructive tissue of choice for most soft tissue defects in the head and neck.

The forearm skin had many of the ideal soft tissue characteristics for optimising reconstruction and rehabilitation. The tissue was malleable, supple and mouldable in three dimensions. It had a reliable pedicle and could be harvested with a two-team approach. But, when the radial forearm could not be used, the adjacent tissue offered identical tissue characteristics. This tissue got its vascular supply from the ulnar artery.

The surgeons reported their review of 30 male and female patients who underwent free tissue transfer using the ulnar fasciocutaneous free flap in head and neck reconstruction.

Defects were located in the oral cavity (n=14), oropharynx (n=12), neck skin (n=1) and soft tissue of the lateral skull (n=3). The transferred skin paddle measured 3 x 5 - 9 x 12 cm (average 7 x 10) centimetres. The area of tissue transferred was 15-108 (mean 70 cm²).

Vessel sizes were smaller than the comparable radial forearm. One patient had complete loss of the skin graft on the donor site. There were no median nerve or other wound-healing problems. Two flaps were lost after surgery.

Indications for use of the ulnar fasciocutaneous free flap were failed Allen's test, use of a less hairy part of the forearm and surgical preference.
The Laryngoscope 2002; 112(12):2155-2160. "The ulnar fasciocutaneous free flap in head and neck reconstruction."

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