Aims: This study aims to define the role and review the current practice of composite radial forearm free flap usage at St George’s Hospital, London.

Methods: A total of 20 composite radial forearm free flaps were used over a five year period (January 2008–December 20012). Data was obtained from the clinical coding system, operative records and clinical notes. The following data was retrieved: demographics, anatomical region reconstructed aetiology of defect, functional and aesthetic outcomes, complications and length of stay.

Results: Of the twenty composite radial forearm flaps, 60% were used in the maxilla, 30% in the mandible and 10% in other areas of the head and neck. These flaps were used in patients ranging from 16 to 89 years in age. Commonest indication was reconstruction of defects following tumour ablative surgery in patients (90%). An algorithm of the use of this free flap as used in our unit currently shall be discussed.

Conclusion: We feel this versatile free flap still has a relevant role in maxillofacial reconstruction and should be a part of the training and reconstructive armamentarium of the maxillofacial surgeon.

Key words: osteocutaneous; radial forearm; composite free flap; microvascular reconstruction