Free Radial Artery Forearm Flap: Advancements in Tongue Reconstruction

This book chapter presents a case report and discussion on the use of the free radial artery forearm flap for reconstructing a defect in the lateral border of the tongue caused by squamous cell carcinoma. The chapter provides a detailed account of the case presentation, operative procedure, and postoperative period, along with a comprehensive discussion of the free radial artery forearm flap technique.

The case presentation describes a patient with a progressive swelling in the right lateral border of the tongue, clinically suggestive of malignancy. Histopathological examination confirmed moderately differentiated squamous cell carcinoma. The diagnosis was determined to be Stage III (T3N0M0) squamous cell carcinoma involving the right lateral border of the tongue.

The operative procedure involved wide local resection with right hemi glossectomy and reconstruction of the tongue using a free radial artery forearm flap. The tumour was resected with a safe margin, and the defect was measured. The free radial artery forearm flap was marked and raised, preserving its vascular pedicle. The flap was transferred to the oral cavity, and microvascular anastomosis was performed to ensure proper blood flow. The reconstruction of the tongue was achieved, and the donor site in the forearm was closed primarily.

The postoperative period remained uneventful, and satisfactory results were observed during follow-up examinations. Intraoral and photograph showed the satisfactory healing of the reconstructed tongue and the donor site of the free radial artery forearm flap at six months of follow-up.

The discussion section of the chapter introduces the free radial artery forearm flap technique, highlighting its significance in reconstructive surgery, particularly for complex defects in the head, neck, and extremities. The surgical technique, including donor site preparation, flap elevation, recipient site preparation, flap transfer, and microvascular anastomosis, is described in detail. The advantages of the free radial artery forearm flap, such as its versatility, adequate tissue volume, and reliability, are discussed. The limitations, including donor site morbidity, technical complexity, and potential complications, are also addressed.

In conclusion, this book chapter offers valuable insights into the use of the free radial artery forearm flap for reconstructing a defect in the lateral border of the tongue. Through the presentation of a case report, operative details, and a comprehensive discussion, the chapter highlights the efficacy and considerations of the free radial artery forearm flap technique in achieving successful outcomes in reconstructive surgery.