Perforator based sentinel skin Island for monitoring of buried radial artery forearm free flaps in head and neck reconstruction: a technical note and case series

Abstract Background The use of buried free flaps in head and neck reconstruction poses challenges during postoperative monitoring. Previously published techniques often require additional monitoring adjuncts or complex modifications to traditional skin paddles, complicating flap design and inset. Results This technique introduces a perforator-based sentinel skin island as a monitoring solution for buried radial artery forearm free flaps (RAFF). The proposed approach simplifies flap harvest by incorporating a proximal perforator based monitor skin island which is eventually placed along the cervical incision line, allowing direct cutaneous assessment without compromising the main skin paddle or requiring additional vascular systems. Conclusion This technique enables clinical monitoring of the buried free flap in various challenging head and neck scenarios such as pharyngo-esophageal reconstructions, oropharyngeal reconstructions and oral cancer cases with severe trismus.