Osteocutaneous Radial Forearm Flaps for Mandibular Reconstruction

Purpose of Review: The radial forearm free flap has been the mainstay of soft tissue reconstruction for composite defects after tumor ablation in the head and neck. On an anatomic basis, the flap also has the potential to be harvested with a boney component. Up to half of the radial forearm bone can be harvested and included in the flap. This allows the flap to be used not only for composite soft tissue defects but for composite boney defects. Material & Methods: A literature review was performed of articles published in the last 10 years. Recent Findings: When first described, the incidence of radial fracture was unacceptable. This led to most surgeons advocating other reconstructive methods. However, innovations in management of the osteotomy site have decreased the incidence of fracture to almost zero. The morbidity of the harvest site is the same as for the soft tissue flap. The functional reconstruction has been shown to be as good as other boney flaps for the selected defects. Summary: This manuscript describes the innovations and results that have occurred with the radial forearm osteocutaneous free flap in the last decade.