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Bipaddle Radial Forearm Flap for Head and Neck Reconstruction

Zhang, Yi Xin MD*; Xi, Wenjing MD*; Lazzeri, Davide MD; Zhou, Xiao MD; Li, Zan MD; Nicoli, Fabio MD†§; Zenn, Michael R. MD; Torresetti, Matteo MD; Grassetti, Luca MD; Spinelli, Giuseppe MD#

The Journal of Craniofacial Surgery: March 2015 - Volume 26 - Issue 2 - p 350–353
doi: 10.1097/SCS.0000000000001468
Original Articles

Background Although the radial forearm free flap has become a workhorse flap in head and neck reconstruction, the skin grafting of the donor is the main drawback resulting in an unacceptable contour deformity and an unsightly appearance. Several technical modifications have been therefore applied to the radial forearm (RF) flap marking, elevation, and inset to overcome this major shortcoming. In this article, we report our clinical series with the bipaddle RF flap.

Methods The authors described their 11 cases of head and neck oncologic reconstruction with the bipaddle RF flap. The skin island is designed longer and narrower and split into 2 separate skin paddles each nourished by a proximal and a distal independent perforators raising from the radial artery so that the donor site could be closed directly. The narrow design of the skin paddle and the subsequent splitting in its 2 components applying the “perforator-pedicle propeller flap method” allow for the changing of the flap shape according to the shape of the recipient site defect.

Results From 2007 to 2013, the bipaddle RF flap method was used in 11 patients to restore head and neck defects following cancer ablation. The mean age of the patients was 43 years, ranging from 31 to 50 years. The location of the defects was the tongue (n = 7) and the intraoral region (n = 4). The defect sizes varied from 4 × 5 cm to 5 × 6 cm, and the flap maximum width was 3 cm with mean area of 26.4 cm2. The healing was uneventful in all patients with excellent cosmetic and functional results of both donor site and recipient site after 20 months of mean follow-up.

Conclusions The bipaddle RF free flap is a reliable and versatile option for the reconstruction of a wide range of soft tissue defects of head and neck region. This method allows for a customized resurfacing of the defect because of its large variability in shape and size. The harvesting site is closed primarily, and a second donor site for skin graft is avoided.

Clinical Question, Level of Evidence: Therapeutic, IV

From the *Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; †Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy; ‡Division of Head and Neck Surgery, Department of Surgery, Hunan Province Tumor Hospital, Changsha, Hunan, China; §Plastic and Reconstructive Surgery Unit, University of Rome “Tor Vergata”; ∥Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; and ¶Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona; and #Maxillofacial Surgery Unit, Hospital of Florence, Florence, Italy.

Received October 2, 2014.

Accepted for publication December 1, 2014.

Y.X.Z., W.X., and D.L. contributed equally to this study.

Address correspondence and reprint requests to Zan Li, MD, Division of Head and Neck Surgery, Department of Surgery, Hunan Province Tumor Hospital, 582 Xianjiahu Road, Yuelu, Changsha, Hunan, China, 410013; E-mail:

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.