The Use of Reverse Flow Free Radial Forearm Flap in Head and Neck Reconstruction

Abstract The free radial forearm flap (RAFF) is one of the most common flaps used in head and neck reconstruction. Exposure of tendons, limited skin volume, and graft loss are its known drawbacks. The reverse flow RAFF (RF-RAFF) where the skin island is designed over the proximal forearm offers many advantages over the conventional radial forearm free flap. A larger volume of skin is available with the bed being covered with muscle suitable for split-thickness skin graft. Though the use of RF pedicled RAFF is routinely used but surprisingly its use as a free flap is not a practice. This study was a retrospective observational study. Between September 2015 and September 2021, 23 patients of head and neck malignancy were reconstructed with proximal islanded free RF-RAFF. All the flaps survived. One patient had negative reexploration for doubtful venous congestion. One patient had hematoma over the donor site, which was managed conservatively, and there were no graft loss. The RF-RAFF is a reliable free flap, though it is based on a retrograde venous flow. It has the advantage of harvesting larger flap dimension with less donor site complications compared to the conventional radial forearm free flap.