This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bowers, K. W.
Right arrow Articles by Toby, E. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bowers, K. W.
Right arrow Articles by Toby, E. B.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?
The Journal of Bone and Joint Surgery 82:694 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Osteocutaneous Radial Forearm Free Flaps

The Necessity of Internal Fixation of the Donor-Site Defect to Prevent Pathological Fracture*

Kevin W. Bowers, M.D.{dagger}, Joseph L. Edmonds, M.D.{dagger}, Douglas A. Girod, M.D.{dagger}, Gopal Jayaraman, Ph.D.{ddagger}, Chee Pang Chua, M.S.{ddagger} and E. Bruce Toby, M.D.{dagger}

Investigation performed at the Section of Orthopedic Surgery, Kansas University Medical Center, Kansas City, Kansas
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Section of Orthopedic Surgery (K. W. B. and E. B. T.) and Department of Otolaryngolic Surgery (J. L. E. and D. A. G.), Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160.
{ddagger}Department of Mechanical Engineering, Michigan Technological University, Houghton, Michigan 49931.

Background: Osteocutaneous radial forearm free flaps have fallen from favor due to pathological fractures of the radius. The purposes of this study were to propose a means to decrease the rate of pathological fracture by prophylactic fixation of the donor-site defect and to evaluate this technique biomechanically.

Methods: Two groups of ten matched pairs of fresh-frozen cadaveric radii were harvested. In Group 1, an eight-centimeter length of radius comprising 50 percent of the cross-sectional area of the bone was removed to simulate an osteocutaneous radial forearm donor-site defect. This defect was created in one member of each pair, with the other bone in the pair left intact. In Group 2, both members of the ten matched pairs of radii had identical defects created as previously described. However, one radius in each pair had a twelve-hole, 3.5-millimeter dynamic compression plate placed across the segmental defect. In each group, five matched pairs were tested to failure in torsion and five matched pairs were tested to failure in four-point bending.

Results: In Group 1, the intact radius was a mean of 5.7 times stronger in torsion and 4.2 times stronger in four-point bending than the radius with the segmental resection. In Group 2, the radius that was ostectomized and fixed with a plate was a mean of 4.0 times stronger in torsion and 2.7 times stronger in four-point bending than the ostectomized radius.

Conclusions: Removal of an eight-centimeter segment from the radius dramatically decreased both torsion and bending strength. Application of a plate over the defect in the radius significantly restored the strength of the radius (p = 0.01).

Clinical Relevance: The segmental defect created in the radius when an osteocutaneous radial forearm free flap is harvested weakens the donor bone an unacceptable amount, resulting in a high risk of pathological fracture. We believe that prophylactic internal fixation of the donor-site defect with a plate restores strength to such a level that pathological fracture may be prevented, thus increasing the utility of the osteocutaneous radial forearm free flap.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?