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Radial Forearm Flap: Standard Technique

  • Klaus-Dietrich Wolff
  • Frank Hölzle

Abstract

In 1978, a fasciocutaneous free flap from the volar aspect of the forearm and pedicled on the radial artery was first used in China. When this so-called “Chinese flap” was originally described by Yang et al. in 1981 [608] and Song et al. in 1982 [497], both groups already had performed more than 100 successful flap transfers. Shortly after, this technique was popularized by different European surgeons, who visited their colleagues in China. In 1981, Mühlbauer was the first to describe the advantages of the radial forearm flap (RFF) in the European literature, especially its excellent pliability, thinness, the ease of flap raising, as well as the constant anatomy and the long and high caliber vascular pedicle [377, 379]. Very soon, many authors favorized this flap for reconstructions in the head and neck region and for intraoral lining. In a number of publications, Soutar and coworkers reported on different indications of the radial forearm flap for reconstructions of the oral cavity and the hand [501–504], and Cheng used this flap for tongue reconstruction [88]. Hatoko et al. and Chen et al. favorized the forearm flap for defect coverage at the hard and soft palate and thus proposed this flap for the rehabilitation of the cleft lip and palate patient [79, 206]. Apart from a reliable closure of oroantral fistulas, they were able to resurface the alveolar ridge and build a vestibule for reliable fitting of dentures. Moreover, the forearm flap was used as a tubed flap to reestablish the ability of phonation or deglutition by inserting it in defects of the hypopharynx, trachea, or esophagus [82, 199, 606]. By including a bony segment of the radius, an osteocutaneous flap can be raised, which was proposed for mandible reconstruction [377, 504, 507]. Because of the rich vascularization, two or more isolated skin paddles can be built which are suitable for the closure of perforating defects of the oral cavity [54]. Niranjan and Watson described a technique for cheek reconstruction using the tendon of the palmaris longus muscle to elevate the denervated angle of the mouth [394]. Lip reconstructions were performed by incorporating a segment of the brachioradialis muscle into the radial flap, which than was reinnervated by a branch of the facial nerve and sutured to the ends of the resected orbicularis muscle [447, 516]. As another variation, vascularized fascial flaps from the forearm were placed into the oral cavity to allow for reepithelialization and thus to achieve a mucosal surface [332]. When covering the fascia with a skin graft prior to flap raising, ultrathin flaps can be prefabricated which show less shrinkage compared to pure fascial flaps. Moreover, the appearance of the donor site is improved by linear closure of the forearm skin, which is not used for flap raising [588]. Although sensory recovery of the radial forearm flap may be facilitated by anastomosing a branch of the antebrachial cutaneous nerve to a sensory nerve of the recipient site [556], according to clinical experience, sensation will at least partially be reestablished spontaneously after years even without neurocutaneous anastomoses, probably by nerve sprouting.

Supplementary material

Video 1.1

Radial forearm flap (MPG 98598 kb)

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Klaus-Dietrich Wolff
    • 1
  • Frank Hölzle
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryKlinikum rechts der Isar, Technische Universität MunichMunichGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital of RWTH Aachen UniversityAachenGermany

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