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The radial forearm free flap, explained | CION Cancer Clinics
A radial forearm free flap is thin skin and soft tissue from the inside of your forearm, taken with its own small artery and vein and moved into the mouth after part of the tongue is removed. The vessels are joined to vessels in the neck so it stays alive. It fills the gap so the tongue you still have can move freely. This page explains how it is done and who it suits. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is a radial forearm free flap for the tongue?
- How is the flap taken and placed?
- When is a forearm flap used, and when is another chosen?
- What do the words about the flap mean?
- What do people worry about with a forearm flap?
- How do you look after the arm once you are home?
- What can this page not tell you?
- Common questions about the radial forearm flap
The short answer
What is a radial forearm free flap for the tongue?
It is a piece of thin skin and soft tissue taken from the inside of your forearm, along with a small artery and vein, and moved into your mouth to fill the gap left after part of the tongue is removed. The blood vessels are joined to vessels in your neck so the tissue stays alive in its new place.
Why the forearm is so often chosen
The skin on the inner forearm is thin, soft and bends easily. Inside the mouth, that means it does not bulk up the space or stop the remaining tongue from moving. Its blood vessels are long and reliable, which makes joining them in the neck more straightforward.
What it cannot do
The flap has no muscle that you can move and no taste buds. It fills the gap so that the tongue you still have can move, shape sounds and push food back more freely. How well you speak and swallow still depends mostly on how much tongue remains and on therapy.
Who does this part of the operation
Raising the flap and joining its blood vessels is specialist work, often done by a reconstructive or head and neck surgeon trained in microsurgery. In many centres two teams work at once, one removing the cancer and one preparing the flap, which shortens your time asleep. Ask your centre who will do this part and how the two teams work together.
In the operation
How is the flap taken and placed?
Checking the hand first
Before surgery, the team checks that your hand gets enough blood from its second artery, so that removing one from the forearm is safe. This is usually a simple bedside test, sometimes with an ultrasound.
Lifting the flap
While the cancer surgeon removes the tumour, a second surgeon marks out the skin on the forearm and lifts it with its artery and vein.
Joining the blood vessels
The flap is shaped to fit the gap and stitched into the mouth. Its vessels are joined to vessels in the neck under a microscope.
Covering the forearm
The forearm wound is usually covered with a thin skin graft taken from the thigh or tummy, and the arm is dressed and rested in a splint.
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Ask an oncologistIs it the right flap?
When is a forearm flap used, and when is another chosen?
Your surgeon weighs the size of the gap against your arm, your health and your work.
Often a good fit
Gaps after a partial glossectomy or hemiglossectomy, where thin, pliable tissue lets the rest of the tongue move.
Also used for
- The floor of the mouth
- The inside of the cheek
Usually not enough
Total or near-total glossectomy, where a lot of bulk is needed. A thicker flap from the thigh is usually chosen instead.
When the hand test is not reassuring
If the hand relies too much on the artery in the flap, the forearm is not used, and another donor site is chosen.
When your hands are your living
Tell the team if you do heavy manual work, play an instrument, or need fine hand control. They may use your non-dominant arm or a different flap.
On your papers
What do the words about the flap mean?
- Free flap
- Tissue fully detached from its original site and reconnected to new blood vessels elsewhere.
- Donor site
- The place the flap was taken from, here the inner forearm.
- Pedicle
- The artery and vein that travel with the flap and keep it alive.
- Microvascular joining
- Stitching tiny blood vessels together under a microscope.
- Skin graft
- A very thin layer of skin, often from the thigh, used to cover the forearm wound.
- Flap monitoring
- Regular checks of the flap's colour, warmth and blood flow in the first days after surgery.
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Commonly believed
What do people worry about with a forearm flap?
"He will lose the use of his hand."
The hand test before surgery exists to prevent this. Stiffness, weakness in grip and numbness near the scar are common for a while, and most people return to normal daily use of the hand with exercises.
"The skin in the mouth will always feel like arm skin."
Over months the flap becomes moister and softer, and many people stop noticing it. Some hair may grow if the forearm skin was hairy, and this often thins with time or radiotherapy.
"The forearm scar means something went wrong."
The forearm scar and graft are an expected part of this operation. The graft area can look pale or patchy at first and usually settles over the following months.
"A stitched gap would heal just as well."
For a small gap that is true. For a larger one, stitching can tie the tongue down, making speech and swallowing harder. That is when a flap earns its extra hours.
At home
How do you look after the arm once you are home?
- Keep the dressing or splint on until the team says it can come off
- Raise the arm on a pillow to reduce swelling
- Do the finger and wrist exercises you were shown
- Protect the graft area from sun and knocks
- Avoid blood pressure cuffs and needles in that arm
- Call the team if the graft smells, oozes or turns red
Being straight with you
What can this page not tell you?
This page cannot tell you whether a forearm flap is the right choice for you, or whether you need a flap at all. That depends on the gap your surgeon expects, your hands and your general health. It also cannot promise that a flap will take, though most do.
Who free flap surgery may not suit
People with serious heart or lung disease, poorly controlled diabetes, or blood vessels badly damaged by smoking may do better with a simpler repair and a shorter anaesthetic. If you smoke, stopping before surgery helps the flap, and your team can help you do it.
What to ask your centre
Ask who will raise and join the flap, and whether they work alongside your cancer surgeon in the same operation. Ask which arm will be used. Ask how the flap is checked overnight, and what happens if a problem is found out of hours.
Bring a list of every medicine you take, including blood thinners. The surgeon and anaesthetist decide any change. Do not stop anything on your own.Questions we are asked
Common questions about the radial forearm flap
Which arm will they take it from?
Usually your non-dominant arm, so your writing or working hand is spared. The final choice also depends on the hand test and on which side of the neck the vessels will be joined. Tell the team early if you are left-handed or if one arm has old injuries.
What happens if the flap fails?
Most problems show up in the first days, while nurses are checking the flap often. An urgent return to theatre can often fix a blocked vessel. If the flap cannot be saved, the surgeon can usually repair the gap another way, sometimes with a different flap.
Will my arm look very different?
There will be a visible scar on the inner forearm, with a patch of grafted skin that looks different from the skin around it. It is usually flat, and it fades and softens over the following months. Some people cover it with sleeves at first and stop bothering later.
Will I feel the flap in my mouth?
At first it feels numb and strange, a bit like a patch of different skin. Some feeling may return slowly, though not taste. Most people get used to it as swelling settles and speech and eating improve.
When can I use my arm normally again?
Light use comes back first, once the splint is off and the graft has taken. Heavier lifting and gripping take longer. Your physiotherapist or surgeon will tell you when it is safe, based on how the wound is healing, so ask before returning to heavy work.
Does radiotherapy damage the forearm flap?
Forearm flaps usually cope with radiotherapy. The flap may shrink and firm up a little. Radiotherapy dries and irritates the rest of the mouth, so eating and speech may dip during treatment before improving again.
Why does the operation take so long with a flap?
Lifting the flap, shaping it, and joining very small blood vessels under a microscope is slow, careful work. Rushing it raises the chance of the flap failing. Your family should expect a long wait and ask the team how they will be updated.
Is the flap covered by Aarogyasri or insurance?
When done as part of cancer surgery, the flap is usually covered along with the operation. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. Call the helpline with your card and reports for an estimate against your cover.
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Sources
- Cancer Research UK — Mouth and oropharyngeal cancer
- NHS — Mouth cancer: treatment
- Macmillan Cancer Support — Mouth cancer
- American Cancer Society — Oral cavity and oropharyngeal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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