FOLDED FREE RADIAL FOREARM FLAP FOR RECONSTRUCTION OF FULL-THICKNESS DEFECTS OF THE CHEEK

Background. Full thickness defects of the cheek have been conventional ly reconstructed using the folded forehead flap, cervical flap, pector alis major myocutaneous flap, or deltopectoral flap in various combina tions. We report a modified technique of folding the radial forearm fl ap for reconstruction of full-thickness defects of the cheek. Methods. The free radial forearm flap is a type C fasciocutaneous flap based o n the radial artery along with its vena commitans and superficial fore arm vein. The size and shape of the flap are determined according to t he dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is t hen performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent full- thickness excision of the cheek. Results. Flap edema was observed in 4 patients in the immediate post-operative period. Necrosis of the oute r paddle was seen in 1 patient. Donor site morbidity was seen in 4 pat ients who required dressings on an outpatient basis for up to 3 weeks. Conclusion. Single-stage reconstruction of full-thickness defects of the cheek with the folded free radial forearm flap is reliable and pro duces excellent cosmesis with minimal donor site morbidity.