Lip and oral commissure reconstruction with the radial forearm flap

The radial forearm free flap has been a workhorse flap for lip reconstruction due to its pliability, color match, and ability to incorporate the palmaris longus tendon for support. We report our experience with the use of the radial forearm free flap in three patients post-tumor resection.

Between 2009 and 2010, three patients had undergone resection of squammous cell carcinoma of the oral region and simultaneous reconstruction with the radial forearm free flap. The average patient age was 51 years and the average defect size was 4 × 3 cm(2). In two patients, anterograde radial forearm free flap was used with a fascia lata free tendon graft for support and in one patient, a retrograde radial forearm flap was used without the use of tendon as support.

All three patients were satisfied with the initial management of tumor clearance. All three surgical margins were clear. Out of three, two patients complained that the flap was unsightly and were dissatisfied with the appearance and bulk of the flap.

Although the radial forearm flap is recognized as a gold standard for lip reconstruction, there always appears to be a need for secondary revision procedures to further improve both the functional as well as esthetic appearance of the lip reconstruction procedure. As a primary reconstructive procedure, the flap does not satisfy patient expectations. A comprehensive questionnaire as well as objective assessment follow-up study is warranted.