There are many and varied free flaps available for reconstructions. Here is a variant on the workhorse radial free forearm flap. The modification involves a longer, narrower flap that can be rotated back on itself to increase the flap width yet enable primary closure of the forearm defect. It relies on independent proximal and distal perforators to supply each of the paddles. The enabling of primary closure reduces the morbidity of the skin grafted forearm and the graft donor site. This paper reports 11 successful flaps undertaken over a six year period to fill oral cavity and tongue defects. All 11 were complication free with a minimum of three months’ follow-up. By limiting the width of the forearm defect to 3cm they were able to achieve primary closure in all cases. This new variation may overcome one of the major drawbacks of the radial forearm flap. Time will tell if this modification will prove popular with reconstructive surgeons.

Bipaddle radial forearm flap for head and neck reconstruction.
Zhang Y, Xi W, Lazzeri D, Zhou X, Li Z, Nicoli F, Zenn MR, Torresetti M, Grassetti L, Spinelli G.
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Stuart Burrows

FRCS (ORL-HNS), Wellington Regional Hospital, Newtown, Wellington, New Zealand.

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