The radial forearm flap provides a thin layer of subcutaneous fat and skin innervated by the medial or lateral antebrachial cutaneous nerves, or both. The flap can include one or more skin paddles, a portion of the lateral cortex of the radius (usually a 1 cm width and a 10 to 12 cm length can be obtained), and fascia in any combination.1-10 The entire forearm skin can be elevated, but the larger the flap, the greater the donor site deformity. The forearm skin has only a small area with light or no hair growth, which may limit the flap size in some types of reconstruction.

The radial forearm flap is more commonly used:

1. for intraoral reconstruction when a thin supple skin flap is advantageous; 7,11,12

2. for cheek reconstruction when a single flap 7,13 is capable of providing lining and cover;

3. for mandibular reconstruction, particularly when a portion of the horizontal ramus has been resected along with lining or cover; 6,7,11,12

4. in reconstructive surgery of the extremities when a sensitized skin flap is required, such as in thumb reconstruction or resurfacing,3 and heel or foot resurfacing; 14

5. in penile reconstruction. 15

Contraindications

The radial forearm flap should not be chosen when an Allen's test indicates poor filling of the hand from the ulnar artery. This flap should not be used in the obese patient, in whom the skin flap can become quite bulky, and on whom the skin-grafted donor site is particularly noticeable. In a patient concerned about the cosmetic appearance of the forearm, other flaps should be considered first. In post-menopausal women, extreme care should be taken if radial bone is being removed because these individuals may have osteoporosis and are more likely to develop stress fractures.7

Technical Considerations

FLAP INSET

The venous system carrying most of the blood flow (superficial or venae comitantes) can be assessed in the arm after deflation of the tourniquet, and this may influence the choice of veins for anastomosis at the recipient site. Frequently, a branch from the venae comitantes travels to the superfial venous system near the antecubital fossa. If dissection is carried this far proximal, drainage of both systems can be achieved with a single venous anastomosis.11

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