Abstract Background: Free flap procedure has become a gold standard in reconstructive plastic surgery especially
for a difficult wound, a complex tissue defect, or a three-dimensional defect in all areas of the body. At present,
there are many donor sites of free flaps and among them the radial forearm free flap is the most popular free
flap performed at Ramathibodi Hosiptal.
Objective: To retrospectively study the outcomes of 49 consecutive radial forearm free flaps performed
at Ramathibodi Hospital during the 10-year-experience from September 1986 to September 1996.
Materials & Methods: There were 177 different free flaps, and radial forearm free flap was the most
common (49/177 = 33.3%) and reliable flap used for reconstruction of head and neck region including
esophagus, lower and upper extremity defects. All important steps of flap dissections and microvascular
anastomoses were performed by the authors. There were three osteofasciocutaneous radial forearm free flaps
in which a segment of radius was included as a composite free flap for reconstruction of one metatarsal bone
and two hemimandibles. The rest were radial forearm fasciocutaneous free flaps. All secondary defects of the
forearms but one were closed by split-thickness skin grafts. No interposition vein grafts were used for
microvascular anastomoses. No monitoring devices were used post-operatively to observe the viability of the
flaps. Only close observation of clinical signs to detect early vascular compromise was made by surgical
residents and nurses.
Results: Three flaps developed early venous congestion. They were relieved and salvaged by leeches
and the other three flaps with doubtful vascular compromise were immediately explored when thrombectomy,
employing a thrombolytic agent, and redoing microvascular anastomoses were carried out. There were neither
systemic complications nor hospital mortality. All radial forearm free flap reconstructions achieved good and
satisfactory results. As far as the hand function and esthetic appearance of the grafted skin at the forearm were
concerned, the morbidity of the donor site was not significant. No patients developed cold intolerance of the
donor hands. However, a decision should be carefully weighed before harvesting this flap in a young lady.
Conclusion: Based on our experience, we conclude that the radial forearm free flap is safe, reliable,
versatile and ideal for reconstruction of the head and neck region where the subcutaneous fat tissue is less as
well as in the lower extremity.

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