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Video

Head and Neck Surgery

(A517) Cephalic-Only Approach to Radial Forearm Free Flap: Simplifying Reconstruction and Reducing Complications

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Christopher N. Bowman, BS

    Medical Student
    University of Virginia School of Medicine
    CHARLOTTE, North Carolina, United States

    • Co-Author(s)

  • Ryan K. Stepp, BS

    Medical Student
    USC Greenville Medical School
    Greer, SC, United States

    • Senior Author(s)

  • JG

    Jonathan C. Garneau, MD

    Assistant Professor of Otolaryngology
    University of Virginia Department of Otolaryngology - Head and Neck Surgery, United States

    • Co-Author(s)

  • CO

    Connor H. O'Meara, MD, PhD, FRACS

    Head and Neck Oncology and Microvascular Reconstruction Fellow
    University of Virginia Department of Otolaryngology - Head and Neck Surgery
    Charlottesville, Virginia, United States

Disclosure(s):
Christopher N. Bowman, BS: No relevant relationships to disclose.
Ryan Stepp, BS: No relevant relationships to disclose.


Introduction: The radial forearm free flap (RFFF) remains a gold-standard technique for head and neck defect reconstruction, traditionally involving the harvest of both the cephalic vein and vena comitans. However, this approach is often complex and time-intensive. This study explores an alternative method emphasizing cephalic vein harvest alone, hypothesizing that it simplifies the procedure, reduces operative time, and lowers complication rates without compromising outcomes.

Methods: This retrospective analysis evaluated patients who underwent RFFF procedures for head and neck defect reconstruction at a tertiary care center between 2014 and 2025. The study compared outcomes between two surgical techniques: cephalic-only vein harvest and traditional methods incorporating both the cephalic vein and vena comitans. Key outcomes included vascular complications like venous congestion, arterial thrombosis, and spasms. Independent variables included patient demographics, surgical technique (cephalic-only vs. traditional), and flap characteristics. Preliminary analyses assessed the impact of surgical technique on complication rates.

Results: Among 182 patients undergoing RFFF during the study period, the mean age was 63 years (SD = 11.4), with a male predominance (64.3%). Overall complication rates were low but varied by technique. The cephalic-only group had a significantly lower complication rate (4.76%) compared to non-cephalic suprafascial (9.33%) and subfascial (13.8%) techniques. Vascular complications were reduced in the cephalic-only group, with venous congestion at 4.76% versus 6.25% in the subfascial group. Arterial thrombosis and spasms were also less frequent in the cephalic-only cohort, supporting its efficacy in reducing complications.

Conclusions: Cephalic-only RFFF surgery may offer advantages over traditional techniques by reducing specific vascular complications, suggesting a potentially safer approach for patients requiring reconstructive surgery. These findings advocate for a selective approach in vascular handling during RFFF procedures to optimize patients outcomes.