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Versatility of the Radial Forearm Free Flap in Head and Neck Reconstruction. A Study of 58 Cases
Versatilidad del colgajo microvascularizado antebraquial radial en la reconstrucción de cabeza y cuello. Una serie de 58 casos
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A Study of 58 Cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "275" "paginaFinal" => "280" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eduardo Ferrandis Perepérez, María Antón Almero, Alberto Guillén Martínez, Rafael Martínez Hervás, Ángel Pla Mocholí" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Eduardo" "apellidos" => "Ferrandis Perepérez" "email" => array:1 [ 0 => "eduardoferrandis@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Antón Almero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alberto" "apellidos" => "Guillén Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Rafael" "apellidos" => "Martínez Hervás" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ángel" "apellidos" => "Pla Mocholí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Versatilidad del colgajo microvascularizado antebraquial radial en la reconstrucción de cabeza y cuello. Una serie de 58 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 752 "Ancho" => 1696 "Tamanyo" => 81945 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumour locations.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Free microvascularised flaps (FMF) are now a widely-used took in the reconstruction of defects on the head and neck. This reconstructive option makes it possible to select the shape, size and type of tissue needed in each case.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> FMF are hard to prepare, laborious and require anatomical knowledge of regions that are distant from the speciality of the head and neck. N Nevertheless, they can give excellent results in reconstructive surgery and not infrequently are the only option for reconstruction and therefore the conditioning factor which allows a patient to be operated.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The radial forearm microvascularised flap (RFMF) is a type of FMF that is generally used as a fasciocutaneous flap. It was invented and used for the first time four decades ago by the team of Yang,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> a surgeon in Sheinyang general hospital, China; this is why it is also known as the Chinese flap.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The RFMF stands out because it is relatively simple to obtain, versatile and able to resolve complex reconstructive problems seated in the area of the head and neck, without leaving significant sequelae in the donor area.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> This flap is flexible and thin, and its blood supply depends on the radial artery with a dual system of venous return: the concomitant radial veins and the cephalic vein.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study is to present our results in the reconstruction of defects in the head and neck area using RFMF.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">An observational, analytical and retrospective study was performed of a series of 58 cases of reconstructive surgery using RFMF on the head and neck, from January 2002 to July 2019.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patient age and sex data were recorded, together with primary tumour location, the histological type of the tumour, previous radiotherapy (RT), the number of venous anastomoses performed during surgery and the body temperature of the patient immediately after the operation, taken using a digital thermometer at the moment of admission to the Intensive Care Unit (ICU), at 24 h and 48 h after surgery. The major and minor complications that arose during patient follow-up were also recorded, together with the procedures used to resolve them.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Version 24 for the OS X® of the IBM® Statistical Package for the Social Sciences (SPSS)® was used for statistical analysis. Descriptive analysis of the variables included in the study centred mainly on frequency distributions and basic summary measurements (average). Different hypothesis comparison tests were used for bivariant analysis, to relate the dependent variable “Flap viability” (Yes/No) with the independent variables: age, sex, tumour location, previous RT treatment, previous dose of RT, number of venous anastomoses and patient body temperature immediately after the operation.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Description of the Surgical Technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">All of the interventions were carried out simultaneously in two surgical fields by the same surgical team, composed of 4 ear, nose and throat specialists.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Prior to the intervention the irrigation of the hand through the cubital artery and the interosseous arteries was checked to ensure that it was sufficient, using the Allen test.</p><p id="par0050" class="elsevierStylePara elsevierViewall">After it had been designed, the radial fasciocutaneous flap was raised by the subfascial plane. Once the tissues of the flap had been dissected, the vascular pedicule was dissected along a suprafascial plane in the zone of the forearm between the proximal limit of the flap and the flexure of the elbow. At this moment the flap is joined to the forearm solely by the vascular pedicule, which is composed of the radial artery, the concomitant veins and the cephalic vein. This pedicule will not be cut until the moment at which it will be moved to the receptor area, to thereby minimise the duration of ischaemia. The flap may be obtained with the arm in ischaemia due to external compression, or without ischaemia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> We prefer to have the arm without ischaemia, as this makes it easier to see the vessels as they are full, recognising any possible lesions in them reducing the time the flap spends in ischaemia.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Once the pedicule has been cut the vascular circuit is washed with a heparinised solution. The flap is then affixed to the receptor zone. Once the flap has been affixed, the vascular microsuture is performed to re-establish the arteriovenous circuit of the flap. The flap is affixed prior to the vascular anastomosis to prevent it being subjected to traction that may damage the vessels. Intraoperatively and depending on the characteristics of the flap vessels, the decision is taken whether to perform one or two venous anastomoses, as well as the type of anastomosis to be used: end-to-side or end-to-end.</p><p id="par0060" class="elsevierStylePara elsevierViewall">A free skin graft of partial thickness from the thigh is used to cover the forearm, and it is then covered with a compressive bandage until the graft has stabilised.</p><p id="par0065" class="elsevierStylePara elsevierViewall">After surgery the patient is admitted to the ICU for an average of 48 h, after which they remain in a ward until their evolution permits discharge. Flaps are monitored every day by means of a direct visual examination for those which are accessible, and using fibrescopy for those which are not visible from the exterior. When signs of flap viability failure are observed, revision surgery takes places to remove it or the part of the same that is not viable, and it is left to granulate or a new reconstruction is performed, depending on whether the remaining defect is acceptable or would give rise to risk for the patient.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 58 interventions with RFMF were performed in 57 patients: 43 men (75.4%) and 14 women (24.6%), with an average age of 57.7 years (range: 27–83 years). One patient was operated twice with RFMF due to tumour relapse. In 57 cases surgery was performed to remove the tumour and reconstruct the damaged site, and in one case surgery had the aim of closing a pharyngostomy. Of the 58 cases, 28 (48.3%) had received RT in the surgical zone, vs 30 (51.7%) who had never received RT treatment.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The most frequent tumour location was the mobile tongue, in 13 cases, following by the tonsillar fossa in 9 cases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).The most common histological type was epidermoid carcinoma (56 cases), followed by adenocarcinoma (1 case) and sarcoma (1 case).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A single venous anastomosis was performed in 46 cases (79.3%), vs the 2 remaining cases (20.7%) in which a double venous anastomosis was performed. The average body temperature of the patients immediately after the operation was 35.6 °C on admission to the ICU, 36.5 °C after 24 h and 36.9 °C after 48 h (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In 10 cases (17.2%) minor complications arose after surgery; the most frequent minor complication was haematoma of the surgical wound (6.9%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Minor complications were managed conservatively in all cases, except for 2 haematomas of the surgical wound in which revision surgery was necessary. No complications in the donor zone were observed.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Major complications arose after surgery in 13 cases (22.4%). We consider total or partial necrosis of the flap and complications which compromise the life of the patient to be major complications (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). One patient died in the post-operative period (before 30 days had passed after surgery) due to respiratory distress. In 10 cases (17.2%) there was total necrosis of the flap, and in 2 cases (3.4%) necrosis was partial. In the cases of total necrosis the most frequent cause of failure was venous thrombosis (70%); the 10 flaps were removed in the operating theatre, and depending on the resulting defect this was reconstructed using a pediculated flap (4 cases) or it was left to granulate before a second attempt (6 cases). One case of partial necrosis occurred in a tonsillar fossa, and another one was in the tongue; in both cases the portion that was not viable and corresponded to the dermis was removed surgically, while the subcutaneous part was viable, and it was left to granulate before a second attempt.</p><p id="par0095" class="elsevierStylePara elsevierViewall">48 (82.8%) of the 58 flaps were viable. No statistically significant relationship was found between any of the variables analysed and necrosis of the RFMF.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Selection of the donor tissue for reconstruction of a head or neck defect depends on many factors, including the clinical situation of the patient and their comorbidities, the size and shape of the defect, the state of vessels in the neck and also the preferences, experience and training of the surgeon. Microvascular flaps offer the possibility of selecting the tissues which are the most suitable for the defect to be repaired. There are many types of free flaps that are differentiated from each other by the characteristics of their tissues. However, all of them share the need for the creation of an arteriovenous circuit using vascular microanastomosis for them to function. RFMF is a free, fasciocutaneous flap that is relatively simple to obtain, versatile and with characteristics that make it possible to reconstruct complex defects in different parts of the head and neck.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Our study analyses a total of 58 cases of reconstructive surgery with RFMF in the head and neck. All of these interventions were performed by the same surgical team, and all of the vascular microanastomoses were performed by the same surgeon. 82.8% of the RFMF in our series were viable. The rate of viability cited in the literature for RFMF varies from 71.4% to 96.4%.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The great versatility of RFMF is made clear in the series presented, as there were reconstructions in up to 13 different locations in the area of the head and neck. The zone that was reconstructed the most often was the mobile tongue (13 cases). In agreement with the literature,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> RFMF is one of the treatments of choice for the reconstruction of the mobile tongue, given that it supplies good quality tissue with suitable thickness and flexibility. Moreover, as it does not depend on a bridge for irrigation – as occurs with pediculated flaps – excellent mobility is achieved.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The main complication with FMF surgery is failure of the flap. In our series we found 3.4% of partial failures of the flap, and these seem to be associated with defective irrigation through the perforating vessels that reach the dermis from the radial artery. This may be due to compression or folding. The rate of total failure of the RFMF amounted to 17.2%, and the most frequent cause of failure was venous thrombosis, which agrees with the literature.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The percentage of minor complications amounted to 17.2%, and the most frequent minor complication was haematoma of the surgical wound. According to the literature<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> RFMF is associated with the risk of a pharyngocuteneous fistula in 16%–50% of reconstructions of circumferential hypopharyngeal defects. We prefer to use another FMF (the jejunum) for tubular reconstruction of the pharynx; nevertheless, we have not had any pharyngocutaneous fistulas in the cases we present of tubular reconstruction using RFMF.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Many studies suggest that there is a relationship between an increased risk of flap failure and a range of perioperative variables.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,14–16</span></a> Having received RT is one of the most widely studied factors in connection with the viability of FMF; there are as many studies which conclude that having received RT before the intervention is associated with an increased risk of flap failure,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,17</span></a> as there are of studies that find no such differences.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,18,19</span></a> In our experience we find no differences regarding the viability of the RFMF depending on this variable, although in the group that had received higher doses of RT (70 Gy) flap viability was reduced, with a difference that is not statistically significant. In their series, Benatar et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> associate doses of RT higher than 60 Gy with an increased risk of FMF failure. In our hospital RFMF is a first-choice tool in rescue surgery, and this is justified as no relationship is found between having received RT treatment beforehand and an increased risk of RFMF failure.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The relationship between the number of venous anastomoses performed in the vascular circuit and the risk of FMF failure was also studied. Performing one or two venous anastomoses is an intraoperative decision. The surgeon’s experience is decisive in establishing whether a single venous anastomosis is sufficient for the vascular circuit to work correctly, thereby preventing unnecessary prolongation of the surgical operation. A recent meta-analysis undertaken by Chaput et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> conclude that performing a second venous anastomosis reduces the risk of venous thrombosis; contrary to this result, in our study the differences in RFMF viability in association with the number of venous anastomoses is not significant.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Body temperature after FMF surgery is a parameter that is often analysed in the literature; nevertheless, the published studies refer to the temperature on the surface of the flap rather than systemic body temperature as a predictor of its ischaemic failure.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–25</span></a> The same papers describe the limitations of the technique: firstly, because flaps inside the oral cavity, pharynx and larynx are protected from the exterior, it takes time for their temperature to fall even though they cease to be irrigated. Secondly, access to them from the outside is not possible in the majority of cases. On the other hand, the harmful effects of systemic hypothermia during the postoperative period constitute a field that has been widely studied and described, and it is associated with a tendency towards vasoconstriction.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26,27</span></a> Our study analyses the relationship between systemic body temperature and RFMF failure: it found no statistically significant differences for RFMF failure in association with body temperature; nevertheless, the variability that arises in patient temperature intra- and postoperatively would require a more detailed analysis to make it possible to establish whether there is a relationship between hypothermia and flap failure.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">Microvascular flaps play an outstanding role among the options for reconstruction, and RFMF is one of the most interesting options for head and neck reconstruction. We consider this flap to be relatively easy to obtain, it leaves minimum sequelae in the donor area, and it offers very high quality tissue. It is a very useful tool that makes it possible to reconstruct a large number of locations where head and neck surgeons work.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1387861" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1273413" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1387860" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1273412" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Description of the Surgical Technique" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-01" "fechaAceptado" => "2019-10-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1273413" "palabras" => array:4 [ 0 => "Radial forearm free flap" 1 => "Reconstruction" 2 => "Head and neck" 3 => "Risk factors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1273412" "palabras" => array:4 [ 0 => "Colgajo microvascularizado antebraquial radial" 1 => "Reconstrucción" 2 => "Cabeza y cuello" 3 => "Factores de riesgo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The radial forearm free flap (RFFF) is a widely used tool in head and neck reconstructive surgery. It stands out as a relatively simple flap to achieve; it is versatile and has features that enable the reconstruction of complex head and neck defects. The aim of the study was to present our results using the RFFF in the reconstruction of seated defects in the head and neck area.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A retrospective, observational and analytical study that included 58 cases of RFFF interventions, performed between January 2002 and July 2019. The data studied were the age and sex of the patients, location of the tumour, histological type, previous radiation therapy (RT), number of venous anastomoses performed in the surgery and body temperature in the immediate postoperative period, at 24 and 48 h following surgery.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The percentage of viable RFFF was 82.8%. None of the variables analysed appear to be a risk factor for flap failure. The most frequent cause of flap failure was venous thrombosis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Microvascularised flaps play an important role in reconstructive surgery, the RFFF being one of the most interesting for head and neck reconstruction. It is a very versatile tool that allows the reconstruction of many of the sites where the head and neck surgeon operates.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El colgajo microvascularizado antebraquial radial (CMAR) es una herramienta ampliamente utilizada en la cirugía reconstructiva de cabeza y cuello. Destaca por ser un colgajo relativamente sencillo de obtener, versátil y con características que permiten la reconstrucción de defectos complejos de la cabeza y el cuello. El objetivo del estudio es presentar nuestros resultados en la reconstrucción con CMAR de defectos que asentaban en el área de la cabeza y cuello.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo, observacional y analítico, en el que se incluyen 58 casos de intervenciones con CMAR, realizadas entre enero del año 2002 y julio de 2019. Los datos estudiados fueron la edad y el sexo del paciente, la localización del tumor, el tipo histológico, la radioterapia (RT) previa, el número de anastomosis venosas realizadas en la cirugía y la temperatura corporal en el postoperatorio inmediato, a las 24 y a las 48 h de la cirugía.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El porcentaje de CMAR viables fue del 82,8%. Ninguna de las variables analizadas parece ser un factor de riesgo para el fallo del colgajo. La causa más frecuente de fallo del colgajo es la trombosis venosa.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Los colgajos microvascularizados tienen un papel destacado en la cirugía reconstructiva, siendo el CMAR uno de los más interesantes para la reconstrucción de cabeza y cuello. Constituye una herramienta muy versátil que permite la reconstrucción de gran cantidad de localizaciones en las que trabaja el cirujano de cabeza y cuello.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferrandis Perepérez E, Antón Almero M, Guillén Martínez A, Martínez Hervás R, Pla Mocholí Á. Versatilidad del colgajo microvascularizado antebraquial radial en la reconstrucción de cabeza y cuello. Una serie de 58 casos. Acta Otorrinolaringol Esp. 2020;71:275–280.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 752 "Ancho" => 1696 "Tamanyo" => 81945 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumour locations.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Viable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not Viable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Average age</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.8 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (81.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.44</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (71.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (28.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment with radiotherapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.43</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (83.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Previous dose of radiotherapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>50 Gy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.06</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>60 Gy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (80.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (20.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>66 Gy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>70 Gy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Number of venous anastomoses</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (78.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (21.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.68</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (83.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Average body temperature (°C)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At admission to the ICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At 24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At 48 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2382453.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Relationship of the Variables Studied With RFMF Viability.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Minor complications</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (17.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Surgical wound haematoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (6.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Local haemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cervical abscess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Major complications</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (22.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total necrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (17.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Partial necrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Donor zone complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2382452.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Principles of reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.C. Neligan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "P.C.Neligan, F.C.Wei" "titulo" => "Microsurgical reconstruction of the head and neck" "paginaInicial" => "129" "paginaFinal" => "134" "serieFecha" => "2010" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radial forearm flap" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.S. Soutar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "F.C.Wei, S.Mardin" "titulo" => "Flaps and reconstructive surgery" "paginaInicial" => "321" "paginaFinal" => "337" "serieFecha" => "2009" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The radial forearm flap: a versatile method for intra-oral reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.S. Soutar" 1 => "L.R. Scheker" 2 => "N.S. Tanner" 3 => "I.A. McGregor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0007-1226(83)90002-4" "Revista" => array:7 [ "tituloSerie" => "Br J Plast Surg" "fecha" => "1983" "volumen" => "36" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6821714" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673618310705" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forearm free skin flap transplantation: a report of 56 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.F. Yang" 1 => "P.J. Chen" 2 => "Y.Z. Gao" 3 => "X.Y. Liu" 4 => "J. Li" 5 => "S.X. 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