Challenges in Radial Forearm Free Flap Surgery

The radial forearm free flap (RFFF) has emerged as a leading option for microvascular reconstruction of head and neck soft-tissue defects. Despite the favorable outcomes conferred by RFFFs, complications such as skin graft loss and tendon exposure can occur. We present the case of a 77-year-old man who underwent RFFF reconstruction after excision of squamous cell carcinoma from the head and neck. The patient subsequently developed flexor tenosynovitis, septic arthritis of the wrist, and osteomyelitis of several carpal bones as a direct result of partial skin graft loss and prolonged tendon exposure at the donor site. To the best of our knowledge, this is the first reported case of this specific complication. Review of the literature reveals the need for continued research into RFFF donor site complications to mitigate the incidence of significant morbidity.