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Frontotemporal Reconstruction With Hydroxyapatite Cement and the Radial Forearm Free Flap
Uttam K. Sinha, MD;
Shane Zim, MD;
Dennis Maceri, MD
Arch Facial Plast Surg. 2001;3:271-276.
Background Contemporary surgical reconstruction of extensive frontal and temporal
bony and soft tissue defects requires the use of myocutaneous free flaps.
These flaps are associated with donor site morbidity, lengthy operative time,
and lack of rigid protection for the brain. To circumvent these problems,
we introduce a new surgical technique for reconstruction of frontotemporal
defects.
Objectives To evaluate and discuss hydroxyapatite and radial forearm free flap
(RFFF) reconstructive options for patients with soft tissue and bony defects
in the frontal and temporal regions after ablative cancer surgery.
Methods Eight consecutive patients with extensive soft tissue and bony defects
in the frontal and temporal regions underwent primary reconstruction with
hydroxyapatite cement for replacement of bone, and the RFFF for soft tissue
coverage. Patient follow-up ranged from 6 to 48 months. Outcome was determined
in terms of immediate and delayed postoperative complications, donor site
morbidity, and long-term aesthetic results.
Results Excellent bony and soft tissue contour restoration was achieved in all
patients. The bony and soft tissue volume was maintained throughout the follow-up
period. One patient had a stroke. No other postoperative complications were
encountered. Morbidity from RFFF harvest was minimum.
Conclusions The combination of hydroxyapatite cement and the RFFF is a viable alternative
to the conventional myocutaneous free flap reconstruction of extensive frontotemporal
defects. This technique provides excellent aesthetic results, provides rigid
protection for the brain, produces minimal and well-tolerated donor site morbidity,
and reduces operative time by avoiding intraoperative changes in patient position.
From the Department of Otolaryngology–Head and Neck Surgery,
University of Southern California School of Medicine, Los Angeles.
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