Versatility of the Forearm Flap in Head and Neck Cancer Surgery

Summary Background: This study demonstrates our experience in the use of the radial forearm flap in head and neck surgery and describes the complications that may arise from this procedure. Methods: A prospective analysis of 55 radial forearm flap reconstructions in patients undergoing surgery for head and neck cancers was undertaken between February 1993 and December 1996. There were 53 cases of squamous cell carcinoma (96%), one rhabdomyosarcoma, and one mucoepidermoid carcinoma. Results: Sites of surgical defects were oropharynx in 38 cases (69%), oral cavity in 10 (18%), face in four (7%), and hypopharynx in three (6%). Two flaps could not be left in place, one due to an anatomic abnormality demonstrated by absence of radial artery fasciocutaneous proximal perforations and the other to absence of venous outflow. Arterial and venous thrombosis occurred in eight (15%) patients, with a flap salvage rate of 63% (5/8). Flap loss rate was 9%. Other perioperative local complications included partial necrosis of three flaps, suture dehiscence in five cases, fistula in five cases, and hematoma in four. Eleven patients experienced systemic complications, all with pneumonia, and one died due to septic shock. Long-term complications were trismus in nine patients and local infection in two. The forearm flap allows one-step reconstruction of large tissue defects in the head and neck region. Morbidity at donor site is minimal and easily managed. Flap loss rate is low but continues to be the most important complication.