The radial forearm free flap is a fasciocutaneous flap that has become a workhorse technique for reconstructing moderate to large head and neck defects. Based on the radial artery, it provides thin, pliable skin with a long, versatile vascular pedicle.

Anatomy and Blood Supply

The flap is supplied by the radial artery and venae comitantes. The radial artery courses along the lateral forearm deep to the brachioradialis muscle. Fasciocutaneous perforators supply overlying skin. The flap can be harvested including the radial bone for composite defects.

Indications

The radial forearm flap is ideal for head and neck reconstruction after cancer ablation. It can provide external skin coverage, resurface intraoral lining defects, and reconstruct partial or total glossectomy defects. The reliable skin quality and pedicle length allow reconstruction of multiple sites from one flap.

Surgical Technique

The flap is elevated from distal to proximal in the subfascial plane. The radial artery and venae comitantes are carefully dissected proximally until adequate pedicle length is obtained. The donor site is skin grafted. Microvascular anastomoses are performed to recipient vessels in the head and neck.

Advantages

The radial forearm flap provides thin, pliable fasciocutaneous tissue with minimal donor site morbidity. The long vascular pedicle provides flexibility. The relatively hairless skin provides a good aesthetic result. Two team approaches allow simultaneous tumor resection and flap harvest.

In summary, the radial forearm free flap has proven to be a workhorse technique for head and neck reconstruction. The reliable skin quality, vessel caliber, and pedicle length make it a versatile choice for a variety of moderate to large oncologic defects.

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