Iatrogenic Damage of the Pedicle of Radial Forearm Free Flap Repaired with Super-Microsurgery Techniques: A Case Report

Jonathan Velazquez- Mujica, Hung Chi Chen, Juan Carlos Reyes Cerda


Introduction: Accidental Iatrogenic damage of the pedicle or perforators has been frequently reported as a cause of failure of free flaps. Free radial forearm flap helps to cover defects that are not possible to cover with local flaps or skin graft.

Case Presentation: A 91 years old patient with Bowen Disease had multiple actinic keratosis and a history of squamous cell carcinoma over the forehead, which was removed 4 years before. The recurrent tumor was detected and wide excision of the tumor was done. It resulted in a large defect of 8 x 5.5 cm2 in diameter at the forehead with exposure of bone, therefore, a free radial forearm flap was performed for reconstruction with right superficial temporal artery and vein as recipient’s vessel. We observed leakage of blood through the radial artery near to the anastomosis due to iatrogenic damage during flap harvesting.

Conclusions: Nowadays, repairing iatrogenic damage through the main pedicle or perforators of the pedicle is possible with super-microsurgery technique due to the improvement of the skills and smaller sutures avoiding the obstruction of the lumen of the pedicle or perforator. This is considered a salvage procedure instead of harvesting new free flaps and can be useful for all kinds of free flaps.


Bowen’s disease, forearm flap, perforator damage, supermicrosurgery


Wei FC, Demirkan F, Chen HC, Chuang DC, Shen SH, Lin CH, Cheng SL, et al. The outcome of failed free flaps in head and neck and extremity reconstruction: What is the next in reconstructive ladder?. Plast Reconstr Surg. 2001;108(5):1154–60.

Copelli C, Tewfik K, Cassano L, Pederneschi N, Catanzaro S, Manfuso A, Cocchi R. Management of free flap failure in head and neck surgery. Acta Otorhinolaryngol Ital. 2017;37(5):387–392.

Ross G, Yla-Kotola TM, Goldstein D, Zhong T, Gilbert R, Irish J, Gullane PJ, et al. Second free flaps in head an neck reconstruction. J Plast Reconstr Aesthet Surg. 2012;65(9):1165–8.

Soutar DS, McGregor IA. The Radial Forearm flap in intraoral reconstruction: The experience of 60 consecutive cases. Plast Reconstr Surg. 1986;78(1):1–8.

Sweeny L, Eby B, Magnuson JS, Carroll WR, Rosenthal EL. Reconstruction of scalp defects with the radial forearm free flap. Head Neck Oncol. 2012;4:21.

Saint-Cyr M, Mujadzic M, Wong C, Hatef D, Lajoie AS, Ronrich RJ. The radial artery pedicle perforator flap: Vascular analysis and clinical implications. Plast Reconstr Surg. 2010;125(5):1469–78.

Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, He SP. Forearm free skin flap transplantation: A report of 56 cases. 1981. Br J Past Surg. 1997;50(3):162–5.

Megerle K, Sauerbier M, Germann G. The evolution of the pedicled rafial forearm flap. Hand. 2010;5(1): 37–42.

Jones BM, O’Brien CJ. Acute ischaemia of the hand resulting from elevation of a radial forearm flap. Br J Plast Surg. 1985;38(3):396–7.

Salibian AH, Menick FJ, Talley J. Microvascular reconstruction of the nose with the radial forearm flap: A 17 year experience in 47 patients. Plast Reconstr Surg. 2019;144(1):199–210.

Kim JT, Youn S, Lee JH, Kim YH. Salvage of free flaps by supermicrosurgical techniques following accidental rupture of the perforator pedicle. J Plast Reconstr Aesthet Surg. 2013;66(7):1010–2.

Koshima I. Microsurgery in the future: Introductin to super-microsurgery and perforators flaps. Presented at the first International Course on perfortor flap and Arterialized skin flaps. Special invited lecture. 1997

Isao Koshima, Takumi Yamamoto, Mitsunga Narushima, Makoto Mihara, Tayoko Iida, Perofators Flaps and Supermicosurgery. Clin Plast Surg. 2010;37(4):683–9.

Full Text: PDF

DOI: 10.33371/ijoc.v14i1.696

Article Metrics

Abstract view : 176 times
PDF - 70 times


  • There are currently no refbacks.

Copyright (c) 2020 Indonesian Journal of Cancer

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.