Pedicled Radial Forearm “Free” Flap for Intraoral Reconstruction Based on an Unexpectedly High Origin of the Radial Artery—Case Report

<b>Background:</b> Radial forearm free flap (RFFF) is considered one of the workhorses in modern head and neck reconstruction surgery due to its technical simplicity, versatility and less time-consuming harvest. <b>Methods:</b> In this report, we present the case of a 56-year-old woman with sublingual squamous cell carcinoma (SCC) who underwent surgical resection and reconstruction of the defect with a RFFF. <b>Results:</b> The preoperative Allen test showed normal blood flow, and the ultrasound did not recognize any blood vessel abnormalities in the left arm. However, during the RFFF harvest, when the dissection of the pedicle came to the cubital fossa, there was no brachial artery bifurcation. While trying to find the bifurcation, the dissection almost came to the axillary region. Hence, the RFFF was converted to a pedicle flap and was pulled through to the intraoral defect where it was used for reconstruction. <b>Conclusions:</b> Hence, during the preoperative radiological ultrasound, besides the usual characteristics such as the radial artery diameter, flow and possible obstructions, it is also important to explore if there are any other anatomical abnormalities that could influence the operation.