Use of the radial forearm free flap in eyelid and orbit defect reconstruction: A systematic review and meta-analysis

The radial forearm free flap (RFFF) is widely used in head and neck reconstruction and serves as a versatile option for complex soft tissue eyelid and orbital socket reconstruction, particularly following orbital exenteration. This study evaluated the success and complication rates of RFFF in these contexts.

A literature search of the PubMed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal electronic databases was conducted (PROSPERO registration number CRD42024584536).

Twenty-two studies met the inclusion criteria, reporting 40 RFFF procedures in 40 patients (ages: 21-93, M:F 2.1:1). Of these, 65% (n=26) of the RFFFs were used for orbital socket reconstruction, with 75.7% (n=28) performed after cancer resection. The pooled success rate of the RFFFs in orbital and eyelid reconstruction was 92.8% (95% CI, 83.25 to 100, P = 0.39, I² = 5%) and the pooled complication rate was 8.62% (95% CI, 0% to 24.98%, P<0.01, I² = 78%). Flap failure occurred in 10% (n=4) of cases, primarily due to wound dehiscence (n=2).

RFFFs demonstrate success and complication rates comparable to traditional flaps used in eyelid and orbital reconstruction, such as the anterolateral thigh, rectus abdominis and latissimus dorsi flaps. It offers functional and cosmetic benefits, particularly for reconstruction after orbital exenteration. The RFFF is a reliable option for complex orbital and eyelid reconstructions and should be considered when local options are unavailable. Standardised reporting and further research are needed to validate long-term outcomes and minimise donor site complications.