The "workhorse" of microvascular reconstruction. Dr. Manish Tiwari expertly utilizes the highly pliable tissues of the forearm to reconstruct the tongue, inner cheek, and soft palate—restoring vital speech and swallowing functions.
Rebuilding the volume and mobility of the tongue following a partial or near-total glossectomy.
Replacing the inner lining of the cheek to prevent severe scarring and locked jaw (trismus).
Re-establishing the delicate barrier between the mouth and nasal cavity to preserve speech resonance.
Reconstructing the base of the oral cavity safely without restricting the movement of the remaining tongue.
Not all tissue is the same. The inside of the mouth requires thin, flexible tissue to function correctly. The Radial Forearm Free Flap (RAFF) provides the exact texture and pliability needed for flawless oral restoration.
The skin on the inner forearm is thin and hairless, making it the perfect substitute for oral mucosa (the lining of the mouth). It folds and contours effortlessly into complex, tight spaces like the throat or base of the tongue.
The RAFF can be harvested as a "sensory flap." Dr. Tiwari can carefully extract the forearm's sensory nerves and connect them to the nerves in the neck, allowing patients to regain feeling and sensation in their new reconstructed tongue.
The radial artery provides a long, reliable "leash" of blood vessels. This gives Dr. Tiwari the length needed to easily reach down the neck to perform the microvascular connections safely, away from radiated or damaged zones.
Dr. Tiwari leads a synchronized surgical team to perform the cancer resection and the forearm reconstruction simultaneously, minimizing total anesthesia time.
The oral tumor is completely excised. While this is happening, the reconstructive team begins isolating the exact amount of skin and vessels needed from the forearm.
The RAFF is detached and transferred to the head. The donor site on the arm is then carefully covered and protected using a thin skin graft taken from the thigh.
Using sutures thinner than human hair, the tiny radial artery and veins from the arm flap are permanently sewn into the neck vessels to bring the transplanted tissue alive.
Before we can safely harvest tissue from your forearm, we must ensure your hand will continue to receive perfect blood flow.
Healing involves close monitoring of the new flap in the mouth and the donor site on the arm.
