One of the main disadvantages of the radial forearm flap is the sacrifice o
f a major artery. To overcome this drawback the authors describe a techniqu
e of free transfer of the flap with preservation of the radial artery. The
flap is elevated as a distal row perforator-based fasciocutaneous flap with
a very short segment of the radial artery included in the inverted-T-shape
d arterial pedicle. The venous outflow of the flap is provided by the cepha
lic vein, with accompanying veins of the radial artery left behind. Althoug
h the donor radial artery is repaired primarily, the flap is transferred to
reconstruct a soft-tissue defect resulting from the release of a neck cont
racture after radiotherapy in a 42-year-old patient who had previous excisi
on of a mandibular osteosarcoma. The arterial anastomosis was performed end
to end between the superior thyroid artery and one limb of the arterial pe
dicle, with the other limb ligated. The venous anastomosis was performed en
d to end between the cephalic vein and the external jugular vein. The flap
survived completely and a satisfactory result was obtained. The radial arte
ry is demonstrated to be patent long after surgery, both with Alien's test
and with a Doppler examination. Considering the possible sequelae of the sa
crifice of the radial artery, this technique is obviously advantageous to s
uch patients, even with a nonsatisfactory preoperative Alien's test. This p
erforator-based radial forearm flap is very easy to raise and to transfer,
with anastomoses of large-diameter vessels.