The double-barreled radial forearm osteocutaneous free flap

Objectives/Hypothesis The radial forearm osteocutaneous free flap (RFOCFF) provides a thin pliable skin paddle with up to 11 cm of bone. A limitation of this flap is the thin bone that is obtained and the lack of suitability for dental implants. A minimum depth of 5 mm and height of 10 mm is required for a bony flap to accept osteointegrated implants. We propose that by double barreling the radial bone, it is possible to reconstruct osseous defects with bone of sufficient caliber to accept dental implants. Study Design Retrospective review of our experience with double-barreled RFOCFF. Methods We reviewed all free flaps performed from July 2000 to September 2014 and analyzed patients in whom a radial forearm osteocutaneous flap was used. We then reviewed those who had an osteotomy to form a double-barrel reconstruction. Descriptive data and outcomes were tabulated. Results A total of 458 osteocutaneous free flaps were performed; 75 were RFOCFF and 18 of these were double barreled. All 18 flaps survived. The reconstructed defect size was between 2.6 and 6.8 cm. One patient had dental implants placed at time of surgery that successfully osteointegrated. Postoperative computed tomography scans were available in nine patients and were used to calculate bone dimensions. Bone depth ranged from 7.91 to 13.22 mm, with a mean of 9.77 ± 1.53 mm. Bone height ranged from 8.42 to 17.81 mm, with a mean of 13.82 ± 3.2 mm. Conclusions The double-barreled RFOCFF provides dependable long-lasting bone with adequate bone dimensions to support osteointegrated dental implants. Level of Evidence 4 Laryngoscope, 126:340-344, 2016.