The Use of Radial Free Flap to Reconstruct Defects After Extended Parotidectomy

The use of forearm free flap for reconstruction after extended parotidectomy is suitable for large superficial defects which may involve the skin, external and medial ear, zygomatic arch, and lateral part of malar bone. Due to its big surface and pliability, this flap is useful for extended and irregular skin defects. It is not ideal for deep defects with mandible or skull base resection in which cases we cannot achieve a good functional and aesthetic result. Not all patients with extended parotid tumors need resection of the facial nerve, but due to tumor status, such as extension, perineural spreading, histological pattern, and grading, most of them will undergo postoperative irradiation. For these cases, the flap ensures a good protection of the facial nerve against radiotherapy. A major disadvantage of this flap is the aesthetical appearance of donor site. In some cases, depending on the resected structures, such as bones, there might be postoperative facial asymmetry, which can be addressed later with lipostructure, leading to good aesthetic and functional outcome. Another immediate postoperative inconvenience is the color difference between the flap and recipient site, but later this will fade away.