Reconstruction of the buccal mucosa following release for submucous fibrosis using two radial forearm flaps from a single donor site

Background: Oral submucous fibrosis is a collagen disorder affecting the submucosal layer and can severely limit mouth opening. The use of bilateral forearm flaps to fill buccal defects following trismus release has proven to be effective and reliable. However, it requires the sacrifice of radial arteries from both forearms. We have developed a technique that allows for the harvest of two independent flaps from a single forearm donor site. Methods: Two separate flaps are designed on the same radial artery and concomitant vein pedicle. The distal flap is marked in the standard fashion and the proximal skin paddle is designed in the middle third of the forearm, based on septocutaneous branches of the radial artery. The two flaps are elevated and subsequently divided into two independent free flaps. Between June 2004 and June 2007, a total of 16 flaps were harvested from eight donor sites for buccal mucosa defects following trismus release. Improvements in mouth opening and buccal pliancy were evaluated by comparing preoperative and postoperative inter-incisal distance (IID) and maximal mouth capacity. Results: All flaps survived completely, and all donor sites were closed primarily, except for one. The mean flap size was 6.6 × 2.6 cm (range: 6 × 2.5 cm-7 × 3 cm), mean pedicle length was 5.7 cm, mean ischaemia time was 46 min and mean total operating time was 8 h 45 min. At an average of 19.8 months follow-up, the inter-incisal distance averaged 29.13 mm, an increase of 20.88 mm compared with the preoperative measurement. The maximal mouth capacity averaged 55.63 cc, an increase of 9.38 cc compared with the preoperative measurement. Conclusion: Two independent small flaps can be harvested safely from one radial forearm donor site. This approach is a useful option for reconstruction of bilateral buccal defects, particularly following submucous fibrosis release. The donor-site morbidity is minimal and limited to one forearm.