FIG. 14-06. Postoperatively, the flap settled fairly well intraorally. The patient was able to eat and drink well and the fistula was completely closed. Side view.

FIG. 14-07. Inferior view.

FIG. 14-08. Intraoral view of lining paddle of skin.

FIG. 14-09. The forearm donor defect was closed with skin grafts, and is well healed. There were no hand function problems.

CASE 2

A 39-year-old woman had a malignant fibrous histiocytoma removed from her forehead.

FIG. 14-10. An attempt at closure with temporoparietal fascia flap was unsuccessful.

FIG. 14-11. Outline of the radial forearm fascial flap planned for cover.

FIG. 14-12. Fascial flap is mobilized proximally on radial vessels.

FIG. 14-13. Flap is laid out. A small skin island was carried with the flap for postoperative monitoring.

FIG. 14-14. Fascial flap and skin island in place. The long vascular pedicle permitted repair of the radial vessels to recipient vessels in the neck. A thin skin graft was used to cover the fascia.

FIG. 14-15. Later the skin island was removed and the entire fascial flap covered with a thick free-skin graft. Front view. The contour is acceptable in the reconstructed area, although there is a slight color mismatch.

FIG. 14-16. Side view.

FIG. 14-17. Because the patient is moderately obese, removal of the fascia and a portion of the subcutaneous fat has left a contour defect in her arm. Although this patient is not particularly concerned about the appearance of her forearm, it is one of the worst donor sites in our series.

CASE 3

A 28-year-old woman twice had a cutaneous malignancy excised from the left side of her nose and skin grafted, followed by radiotherapy.

FIG. 14-18. The patient disliked the color and thinness of the graft. Front view.

FIG. 14-19. Close-up view.

FIG. 14-20. The skin graft was excised and a radial forearm cutaneous flap planned for cover.

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