International Surgery Journal | April 2021 | Vol 8 | Issue 4 Page 1379 International Surgery Journal Balan JR et al. Int Surg J. 2021 Apr;8(4):1379-1381 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Free radial artery forearm flap reconstruction of forehead defect in a 2-year-old child Jyoshid R. Balan*, Vinu Roy, Raj Gopal, Pradeep Kumar K., Ajai K. S. INTRODUCTION The reconstruction of the scalp and forehead defects are not simple to tackle since the aesthetic restoration is a major criterion. The options vary from simple skin grafting to complex tissue expansion and free tissue transfer. Skin grafting requires a vascular bed. One of the options is tissue expansion and the role of expansion is limited in acute stage, and small defects may be managed by acute tissue expansion method. Next option of reconstruction is local flaps in the form of transposition or rotation flap, but they may violate the hair bearing scalp, hair line and direction of the hair and may leave unsightly scar. The advent of free tissue transfer to the field of head and neck reconstructive surgery has greatly expanded the repertoire of techniques available for treating defects of the scalp and forehead. 1 Experienced surgical team and good facilities for microvascular surgery are the most important factors to obtain good results. Free flap reconstruction has rapidly established itself as a desirable and versatile therapy for defects of the scalp, especially in larger and more complex cases. 2 Microsurgery in the pediatric population is challenging because of technical difficulties in flaps dissection as well as microsurgical anastamosis. Reconstruction of the forehead defects may become difficult particularly if traumatic injuries are associated with extensive bone and soft tissue defects. Reconstruction using a very thin and pliable free fasciocutaneous flap would be the ideal choice for reconstruction of defect on forehead which is aesthetically very important area. This case highlights the importance of free tissue transfer in the form of a thin and pliable fasciocutaneous flap for a child for aesthetic reconstruction of forehead. CASE REPORT A 2-year-old boy presented to us with a post traumatic forehead defect on left frontal region with exposed underlying skull devoid of periosteum. On examination there was an oval soft tissue defect in the left frontal region reaching up to the midline with exposed skull devoid of periosteum measuring 4.5×2 cm situated 2 cm above the ABSTRACT Reconstruction of soft tissue defect with exposed bone over the forehead is a technical challenge in pediatric population. The options vary from skin grafting, local flaps to complex microvascular tissue transfer. The local flaps leave unsightly scar in the neighboring area and may violate the hair bearing scalp, hair line and the direction of hair. Skin grafting requires a vascular bed for its take and the aesthetic appearance is inferior. The tissue expansion in an acute stage may not be an option. Here we present our experience of soft tissue reconstruction of a forehead defect in a 2-year-old child with free radial forearm flap (RAFF). To best of our knowledge free radial forearm flap has rarely been reported for usage in reconstruction of forehead defect in pediatric population. Keywords: Free radial artery forearm flap, Pediatric, Forehead defect Consultant Plastic Surgeon, Sushruta Institute of Plastic Surgery, Elite Mission Hospital, Thrissur, India Received: 07 February 2021 Accepted: 11 March 2021 *Correspondence: Dr. Jyoshid R. Balan, E-mail: drjosh4u@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20211330