Radial Forearm Flap
This involves taking an area of skin from the forearm near the wrist along with the Radial artery and vein that supply it.
This has proven to be a very reliable flap over recent years. It is nicely suited to mouth reconstruction because the skin is thin and flexible and the vessels long enough to reach the vessels down in the neck. The vessels are usually a good size making the surgery reliable.
This is a good option particularly for reconstructing soft tissue parts of the mouth – the tongue, floor of mouth, or cheek lining. Previously it was used by some with a piece of bone from the radius for jaw reconstruction but it is no longer the preferred option for this because the amount of bone that can be safely harvested is very limited and the patients can be at risk of wrist fracture.
The surgery to perform a radial flap is usually carried out with a tourniquet above the elbow to further reduce blood loss. Skin and sometimes additionally small nerves or veins are taken from just above the wrist. The radial artery and its accompanying vein are traced all the way back to the elbow to give a good length of blood vessel (pedicle).
Patients subsequently end up with a wound extending the length of the forearm which will be carefully closed with stitches. Additionally usually a skin graft is required to close the defect near the wrist and a dressing will be applied to apply gentle pressure. This dressing is usually left undisturbed for around 7 days to allow graft healing.
Sometimes a small area on the back of the hand can numb or tingly after surgery. Usually the very superficial and small nerves can be preserved but are at risk from handling. This usually settles over time but can occasionally be permanent.
Stiffness of the hand
Sometimes the hand and wrist can feel stiff because of the surgery near the tendons, but usually this settles within a couple of months.
Because the healing at the donor site depends on a skin graft healing, this can sometimes take a few months requiring dressing changes. Patients will normally have a bandage on the arm for a few weeks post-operatively.
Some patients experience some wound infection to the arm, but this usually only requires a short course of antibiotics if it occurs.