1. Free Cutaneous and Myocutaneous Flaps in Oral-Maxillofacial Surgery
Forearm Flap 季彤
JI Tong DDS, MD
Dept. of Oral & Maxillofacial – Head & Neck Oncology
Shanghai Ninth People’s Hospital, Shanghai (200011) China
It is a great pleasure for me to have all of you to this courses and hands-on workshop to develop your skills in microsurgical technique and learning more about head neck reconstruction.
I’m also to thank our local organizer, Faculty of Dentistry，Prince of Songkla University; and Professor Samman to provide this beautiful place to held the course.

2. Oral cavity, pharynx, soft palate, soft tissue defects of face
1978(China) Dr Yang
Oral cavity, pharynx, soft palate, soft tissue defects of face
Thin, pliable skin
Composite flap
Bone, tendon, muscle, nerve

3. Clinical Anatomy Radial artery Cephalic vein (superficial system)
Venae comitantes (deep system)
Up to 20 cm long
Caliber mm
Venae comitantes 1.5mm
Lateral antebrachial cutaneous nerve
Skin territory up to 10x40 cm

4. Vascular
system of
forearm

5. Muscles of the forearm

6. Crossectional anatomy of forearm

7. Possible skin territory supplied by radial artery

8. Flap design Allen test Skin paddle centered over the radial artery
Distal flap border is placed 2 cm proximal to the wrist
Proximal margin depends on the flap size needed
Proximal incision extends along the volar aspect with wavy-line incision

10. Flap harvest Tourniquet
Incision is made through the skin and subcutaneous tissue along toutline of flap
Radial side, dissection down to the fascia over the brachioradialis muscle
identify cephalic vein, superficial branches of the radial nerve
Ulnar side, dissection down to the fascia over flexor carpi radialis muscle and palmaris longus tendon

11. Dissection toward the intermuscular septum and vascular pedicle in the subfascial plane
The radial A & V identified between the brachioradialis and flexor carpi radialis muscles distally, cut, and ligated
Dissection can begin from a distal to proximal direction

12. Defect that usually requires a skin graft
A plane of dissection can be developed under the radial artery
Multiple small branches extend to muscle and require ligation
Defect that usually requires a skin graft

17. Considerations Preoperative considerations Postoperative management
Allen test
No blood draws/IVs in donor arm
Postoperative management
Immobilization of forearm and wrist
Oral intake begin within 2 weeks
Morbidity
Radial nerve injury
Hand ischemia
Stricture formation
Radius fracture (osteocutaneous flap)

18. Thanks