Unusual variation of the radial artery encountered during the elevation of radial forearm free flap

초록

Purpose: The radial forearm free flap (RFFF) is widely used for head and neck reconstruction due to its pliability, ease of elevation, and reliable pedicle length. The radial artery usually lies between the brachioradialis (BR) and flexor carpi radialis (FCR), but anatomical variations may occur with a normal modified Allen’s test. We report this case to emphasize considering the variation. Methods: A 58-year-old man underwent wide excision and modified radical neck dissection for squamous cell carcinoma of the right buccal mucosa and retromolar trigone. RFFF was initially planned, but the radial artery was absent between the BR and FCR, instead running superficially over the BR with the cephalic vein. An aberrant branch was also present between the BR and FCR near the distal radius. Due to difficulty identifying a perforator, reconstruction was converted to an anterolateral thigh (ALT) free flap, and the elevated radial forearm flap was used as full-thickness skin graft at the donor site. Results: Because of this radial artery variation, the plan to reconstruct with RFFF is changed into ALT free flap. ALT flap and FTSG from RFFF was well taken without complication. The patient is still under follow-up with good condition. Conclusion: RFFF is preferred because of its constant anatomy of radial artery. But, some reports, including this