What is Radial Forearm Free Flap Procedure

Radial forearm free flap procedure is surgery to remove tissue and blood vessels from the forearm to replace or repair tissue elsewhere on the body. This procedure may be done to repair an area of tissue that was damaged from the removal of a tumor or from another disease or injury.

The radial forearm is the part of the forearm over the radial artery, which is located just above the wrist.

During this procedure, tissue and blood vessels are taken from the radial forearm (donor site) and transplanted to another part of the body, such as the neck or hand (recipient site). In some cases, bone and tendons are also removed and transplanted to the recipient site.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Whether you smoke or use tobacco products. These can interfere with anesthesia and slow the healing process.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Blood clots.
• Weakness in the area where the tissue and blood vessels were removed.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Plan to have someone take you home from the hospital.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• You may have blood or urine samples taken.
• You may have imaging tests done, such as an ultrasound, CT scan, or MRI.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• You will be placed on your back on the operating table. Your arm will be placed on a separate stand or table next to the operating table.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• A tube may be placed in your mouth, nose, or throat to help you breathe.
• An ultrasound may be done on your arm to help locate the radial artery. This artery may be marked.
• A tourniquet will be placed around your arm above the donor site.
• A template or outline may be used to mark the section of arm tissue that will be removed.
• An incision will be made around the outline. First, the tissue and fat will be cut. Then, the underlying blood vessels and radial artery will also be cut. If needed, tendons and bone will also be removed.
• The arm tissue and blood vessels will be gradually lifted away and removed from the arm.
• The radial artery may be reconstructed using the veins around it.
• The donor-site tissue will be attached to the recipient site with stitches (sutures). The tissue and blood vessels from the donor site will be reattached to tissue and blood vessels at the recipient site using tiny stitches (microvascular surgery).
• The wound on the donor site will be closed with sutures. Skin from another part of the body, or artificial skin, may be needed to close the wound (skin graft).
• A bandage (dressing) will be placed over the donor site and recipient site.
• A splint may be placed on your hand and wrist where the tissue was removed.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have IV tubes inserted to provide medicines and nutrients while you are in the hospital.
• You will be given medicines to control pain. You may also be given antibiotics.
• Do not drive for 24 hours if you were given a sedative.
• You may have to wear compression stockings or sleeves. These help prevent blood clots and reduce swelling in your legs and arms.

Summary

• A radial forearm free flap procedure is surgery to remove tissue and blood vessels from the forearm to replace or repair tissue elsewhere on the body.
• The radial forearm is the part of the forearm over the radial artery, which is located just above the wrist.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• You may have to wear a splint on your forearm for 1–2 weeks after the procedure.

Radial Forearm Free Flap Procedure, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Swelling, bruising, and pain in your forearm where the tissue was removed (donor site).
• Swelling, bruising, and pain at the site where the diseased or damaged tissue was removed and replaced (recipient site).
• Sleepiness from the medicines that you were given during the procedure.

Follow these instructions at home:

If you have a splint:

• Wear the splint as told by your health care provider. You may have to wear a splint on your forearm for 1–2 weeks after the procedure. Remove it only as told by your health care provider.
• Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
• Keep the splint clean.
• If the splint is not waterproof, do not let it get wet. Cover it with a watertight covering when you take a bath or a shower.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider when it is okay for you to shower.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Driving

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a splint on your arm.

Activity

• Avoid activities that take a lot of effort (are strenuous) as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop using the antibiotic even if your condition improves.

General instructions

• Keep your donor-site arm raised (elevated) above the level of your heart when you are sitting or lying down.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.
• Wear compression stockings or sleeves as told by your health care provider. These help to prevent blood clots and reduce swelling in your legs and arms.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around an incision.
• You have fluid or blood coming from an incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from an incision.
• You have a fever.

Get help right away if:

• You have severe pain that cannot be controlled with medicine.
• The skin on the donor or recipient site turns yellow, dark red, gray, or black.
• You have increased swelling, redness, or warmth in your arms or legs.
• Your fingers turn white or purple.

Summary

• After this procedure, it is common to have swelling, bruising, and pain in the forearm where the tissue was removed (donor site). You may also have these symptoms at the site where the diseased or damaged tissue was removed and replaced (recipient site).
• Avoid strenuous activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not drive for 24 hours if you were given a sedative, and do not drive or use heavy machinery while taking prescription pain medicine.
• Wear your splint as told by your health care provider.
• Follow instructions from your health care provider about how to take care of your incisions.