Angiologic Observations Following Autologous Vein Grafting and Free Radial Artery Flap Elevation

Abstract

Fifteen cases with radial forearm flap harvesting and autologous vein-graft reconstruction of the missing radial artery portion, are reported. Post-repair follow-up examinations, using segment plethysmography, photoplethysmography, and Doppler ultrasound, demonstrated an angiologic donor site morbidity, even when radial artery reconstruction was performed. Typically diminished blood pressure occurred, in comparison with the contralateral healthy extremity. Index shifting of pulse wave peaks, as well as widening of pulse wave bases occurred, especially in the thumb and index finger. These latter findings appear to be discrete indicators of arterial insufficiency.

Reconstruction of Hand Soft-Tissue Defects: Alternatives to the Radial Forearm Fasciocutaneous Flap

“…Limited retrospective series have identified symptoms in the hand such as cold intolerance, pain, and edema attributed to chronic vascular insufficiency in patients after radial artery forearm flap harvest. 21,22 Confounding these findings is the well-recognized occurrence of identical symptoms after extremity trauma/surgery in patients who have not had a major arterial injury. Furthermore studies using objective measurement techniques (Doppler ultrasound, digital thermography, color duplex imaging) have failed to show vascular compromise after radial artery harvest.…”

Multifactorial effects on the patency rates of forearm arterial repairs

“…In some studies, vein grafting was suggested; however, other studies pointed out that the cases were not symptomatic and that arterial reconstruction was not necessary. 19,23 It is also reported that the ischemic hand symptomatology with different etiologies was successfully treated with late arterial reconstruction. 24 The confusion in symptomatology may be attributable to the differences in follow-up evaluation and etiology.…”

Reverse Radial Forearm Fascial Flap with Radial Artery Preservation

“…However, to produce this flap, a major artery to the hand must be sacrificed, which compromises the viability of the hand [6][7][8][9][10][11][12] and may lead to ischemia. Some authors have recommended reconstructing the radial artery with a vein graft in a RRFF flap [10][11][12]. The vascular inflow to this flap occurs through the cutaneous perforators and the septocutaneous perforators from the radial and ulnar arteries to the forearm fascia.…”

“…Arterial inflow through the superficial and deep palmar arches can be assessed preoperatively with an Allen test by palpation or Doppler ultrasonography. An abnormal Allen test (absent palmar blood flow with radial artery occlusion) or an abnormal Doppler Allen test (no Doppler flow to thumb with radial artery occlusion) indicates an incomplete palmar arch that necessitates radial artery reconstruction if an RRFF flap is raised [6][7][8][9][10][11][12].…”