The "Chinese" flap

This Acrylic on canvas image painted by Brian Morgan depicts an intra-operative view of a radial forearm flap being raised from its donor site. Originally proposed by Chinese surgeons, it is a composite skin and fat flap, kept alive by fine vessels emerging through the forearm fascia and its septae, arising from the radial forearm artery and its accompanying veins. 

In this image, the flap has been fully prepared and its vessels dissected back to the junction between the brachial artery with the radial and ulnar arteries. It is possible to use this flap in a pedicled fashion – being kept attached to its parent blood vessels -to reconstruct any skin and tissue defect which it might reach, for instance the elbow. However, it was most commonly detached from its parent vessels before being microsurgically re-attached, or re-vascularised to recipient blood vessels near the site of a tissue defect. This is known as a “free tissue transfer” or “free flap”. The donor site was then usually covered with a skin graft.

The radial forearm free flap was for some years the most commonly used “workhorse” microsurgical reconstruction employed by plastic surgeons, particularly within the oral cavity and head and neck region. Whilst still in regular use, it has largely been superceded by alternate flaps with less consequential and visible donor sites.