Mandible reconstruction with the radial forearm flap

The radial forearm osteocutaneous flap is arguably the best flap for the restoration of intraoral function following oromandibular reconstruction: As well having ample surface area, its skin is thin, supple, capable of providing separate paddles for lining and cover, and most importantly, capable of reinnervation for sensate oral reconstruction. The donor site is remote from the recipient, allowing a two-team approach without respositioning. The vessels are large and the pedicle is long. The bone is strong but its usable length is short. It lacks vertical height as well as bulk. In low-volume resections the cosmetic results are excellent, but the cosmetic outcome is less satisfactory when bulky tissue has been resected. Bony defects exceeding 10 cm are probably unsuitable for reconstruction with this flap. Forearm skin may be hairy, and when much is taken, the donor site scar is a conspicuous cosmetic defect. Overzealous harvesting of bone, inadequate postoperative splintage, unusual forces, or sheer bad luck can result in a fractured radius. Yet the flap is reliable and the rates of bony union are high. Donor defects may be minimized by meticulous surgical technique, limiting the bone graft to one third of the distal radial circumference, direct wound closure when possible, and appropriate postoperative splintage. Fractures of the radius are rare under these circumstances. With the correct indications, the radial forearm flap has a distinct and unique role to play in reconstructing composite oromandibular defects.