Reconstruction spectrum of head and neck defects using a radial forearm free flap.

Introduction: The radial forearm free flap (RFFF) is one of the cornerstone of reconstructive microvascular surgery in the head and the neck. It is a fasciocutaneous flap, which is mainly used for free flap reconstructions not only in the head and neck region - for its pliability, long vascular pedicle, predictability and possibility for two teams working synchronously.

Material and methods: In our group analysis, we decided to include and evaluate the data of all patients who were treated at our department between March 2018 to April 2024 with diagnoses that resulted in a soft tissue defect in the head and neck area, which was closed using a microvascular radial forearm flap.

Results: In total, in our group of 75 patients in a 6-year period, we used the RFFF for tongue reconstruction, reconstruction of the defects of the floor of the mouth, defects after orbital exenteration, defects in the retromolar area, oropharynx, and midsize cheek defects, temporal, frontal or parotidomasseteric defects. We also use the RFFF as a workhorse to reconstruct midsize defects of the infraorbital region, the lip, the area of the alveolar process of the lower or upper jaws, and the palate.

Discussion and conclusion: From the perspective of overall complications in our group, we performed 75 radial forearm free flaps reconstructions in head and neck region with no flap loss. The RFFF is very reliable free flap, with a very low risk of complications. It should be emphasized that thanks to sufficient venous drainage, supported by including of the cephalic vein into the flap during its harvesting, and by performing at least two venous anastomoses, we did not lose a single radial free flap in our group of patients.