Radial Forearm Free Flap
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Indications • Oral cavity, lip, oropharynx, soft palate • Hemilaryngeal defects, trachea and skull base • Nasal defects, face Circulation • Axial and septocutaneously by the radial artery Constituents • Fasciocutaneous, nerve, bone or tendon Contiguity • Free Construction • Unipedicled • Orthograde flow Conditioning • In the majority of cases: none • Rarely with skin grafts or cartilage Conformation • The skin island is oriented to the shape of the defect. • The flap can be tubed or folded for pharyngeal and soft palate reconstruction, respectively.
B.M. Erovic, P. Lercher, Manual of Head and Neck Reconstruction Using Regional and Free Flaps, DOI 10.1007/978-3-7091-1172-7_27, © Springer-Verlag Wien 2015
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27 Radial Forearm Free Flap
The radial forearm free flap was first harvested by Dr. G.F. Yang in 1981, and popularized by Dr. David Soutar in 1983. It is the most commonly used free flap for reconstruction in the head and neck.
Anatomy Anatomically the forearm is defined as the region from the elbow to the crease of the wrist. The plane that joins the radius and ulna divides the forearm into an anterior/volar and a posterior/dorsal compartment. The antebrachial fascia, a dense membranous tissue, originates from the olecranon. It terminates as, and also forms, the volar carpal ligament distally. Beneath the fascia, the forearm muscles may be divided into three groups (Fig. 27.1). The radial group, including the extensor carpi radialis longus, and brevis muscles (a) and the brachioradialis muscle (b) arise from the lateral humeral epicondyle, whereas the flexor group with the flexor carpi radialis (c), palmaris longus (d), flexor digitorum superficialis (e), flexor carpi ulnaris (f), and profundus muscles arise from the medial epicondyle and the epicondylar ridge. The third group includes muscles from the dorsal compartment. Innervation is provided by the median nerve, except for the flexor carpi ulnaris, which is innervated by the ulnar nerve. 27.1
d b a
f
c e
Blood Supply
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Blood Supply The radial artery, and its perforators located between the brachioradialis, the radial extensors, the pronator teres, and the flexor muscles, supplies the skin paddle of the fasciocutaneous radial forearm free flap (Fig. 27.2). When harvesting an osteofasciocutaneous radial forearm free flap, the fascioperiosteal branches of the radial artery are found to supply the rim of the radial bone. Venous drainage is ensured by the cephalic vein or the accompanying veins of the radial artery. 27.2
The vascular pedicle can be harvested up to a length of 25 cm, depending on how the flap with the skin island is designed. The radial artery and the cephalic vein are 2.5–4 mm in diameter, whereas the venae comitantes of the radial artery are only 1.0–2.0 mm.
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27 Radial Forearm Free Flap
Innervation The median (from the medial cord of the brachial plexus), the lateral antebrachial cutaneous nerve (from the musculocutaneous nerve), and the superficial branch of the radial nerve (from the posterior cord of the
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