Purpose: Use of radial artery free flaps for large defects is denounced because of the unacceptable grafted donor defect. Use of radial artery fascial free flaps leaves only a volar linear forearm scar, creates larger vascularized flaps, provides “macro-micro” easy vascular anastomoses for old surgeons; and with vein graft radial artery reconstruction, leaves minimal donor cost. Nonetheless, temporalis, arm and back fascial free flaps seem more popular. Five arm and leg cases are chosen to illustrate the ease, versatility, and technical suggestions for this method.

Methods: These cases include circumferential late wrist reconstruction with volar contracture release, proximal carpectomy, and extensor tendon grafting following train injury; hand dorsum reconstruction with extensor tenolysis in a fisherman who fell into a chum bucket with subsequent vibrio septic shock and necrosis; two Achilles tendon coverage cases, and one heel reconstruction over exposed calcaneal avulsion.

Results: All flaps survived, although one skin graft proved unstable and was regrafted. All reconstructed radial arteries remained patent beyond ten-year follow-up, contrary to some speculation.

Conclusion: The radial artery fascia provides an underutilized free flap the size of the entire volar forearm, particularly useful over tendon gliding surfaces of large defects. Reconstructed radial arteries remained patent and the grafts durable, even on the heel.