Angioembolization of a leaking radial artery pseudoaneurysm in a radial forearm free flap

A radial forearm free flap (RFFF) is used frequently in oral and pharyngeal reconstruction. Pseudoaneurysms within RFFFs and their management have not been previously reported.

In the present case, a patient with chemoradiation failure of the right base of the tongue clear cell carcinoma underwent salvage resection and failed reconstruction with pectoralis major muscle flap. He subsequently underwent RFFF reconstruction with delayed development of a radial artery pseudoaneurysm at the site of a previous arterial line within the RFFF, which was not present perioperatively. A rupture of this pseudoaneurysm manifested with recurrent bleeding. Angiography with embolization successfully arrested the bleeding without compromising the flap.

Ruptured pseudoaneurysm of the radial artery within the RFFF is a rare and life-threatening complication, which in the posterior oral cavity and pharynx can be effectively managed with angioembolization.