Vascular anomalies of radial forearm free flap: Systematic approach to avoid complications

Abstract

Introduction: The radial forearm free flap (RFFF) quickly became the workhorse for oral cavity and oropharyngeal reconstruction. The Allen's test is relied on preoperatively to determine the suitability of the radial forearm skin for a free flap. The aim of our study is to discuss the different anomalies of the radial artery (RA), highlighting scenarios when Allen's test is not accurate, and we report a rare anomaly of RA anatomy we encountered while raising the flap. Case report: During a RFFF harvest, the RA was found to travel underneath the pronator teres muscle. The superficial venous system was running superficial to the muscle and the deep venous system was running deep. This anomaly has been reported only three times thus far. We report this case to highlight our strategy for addressing the RFFF in a systematic way to avoid complications from unexpected vascular anomalies with a literature review of all other anomalies. Discussion: Free flap surgeons should be aware of vascular anomalies of the forearm that may affect flap harvest. We will focus in our discussion on preoperative detection, intraoperative management and precautions to vascular injury.

Keywords

• Vascular anomalies
• Radial forearm
• Free flap
• Radial artery