The superficial radial artery-a cautionary tale of two pedicles.

The radial forearm free flap is a common reconstructive option following ablative head and neck surgery. Although uncommon, anatomical variants such as radial artery anomalies pose risks to flap harvest and viability. A rare case of a common radial artery that branched distally into a superficial radial artery and a deep radial artery is reported here. Identified intraoperatively, the superficial radial artery had a radial, superficial course lateral to the cephalic vein. The preoperative Allen test was normal, but a weak radial pulse prompted thorough intraoperative assessment, including Doppler and occlusion testing. This case highlights the importance of recognizing anatomical variations, employing preoperative duplex ultrasound if needed, and ensuring meticulous dissection to optimize flap outcomes.