Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of the oral cavity

The aim of this study was to report the applications, complications, and limitations of the radial forearm flap when used for reconstruction after excision of cancers in the mouth. Patients and methods: We reviewed records in our database from October 1987 to December 2002; a total of 505 patients had surgical defects of the head and neck reconstructed with a radial forearm flap: 258 patients had oral cancers, of whom 173 were men and 85 women, median age was 70 years. Five patients had two reconstructions (total 263), of which 247 were fasciocutaneous and 16 osseofasciocutaneous flaps. Mucosal squamous carcinoma accounted for 97% of the primary cancers. Results: There were nine failures of the flap (3.4%) and four episodes of partial necrosis. Four patients (2%) died within 30 days of operation. Orocutaneous fistulas appeared in nine patients (3.4%), 10 patients had wound infections, and nine had haematomas. The nine failed flaps were replaced by a second free flap in one patient, a pectoralis major flap in three, a buccinator myomucosal flap in one, a skin graft in one, and the remaining three defects healed by secondary intention. There was one failure and one partial failure among the 16 osseofasciocutaneous flaps.