Forearm flap in orthopaedic and hand surgery

Abstract

This study was undertaken in order to evaluate the usefulness of the forearm flap in reconstruction of severe injuries of the upper and lower extremities. A total of 34 patients with extensive skin defects of the upper and lower extremities were treated using radial forearm flaps during the last 4 years. Twenty-four patients had lower extremity injuries, while the remaining ten had upper extremity reconstruction. In two patients, the radial forearm flap was used as an island flap in retrograde direction for coverage of skin defects of the dorsum of the hand. In two patients, the palmaris longus tendon was included in the flap to reconstruct the extensor tendon of the index finger. In one patient, it was used as an innervated flap to cover a skin neurotrophic defect of the sole of the foot. None of the patients had the bony portion of the radius included. Of the 34 flaps, 29 survived. Of the remaining 5, 3 failed totally and 2 partially. The 2 partially failed flaps required reoperation and revision of the venous anastomosis, which was found to be occluded. The patients, eight women and twenty-six men, were examined and questioned regarding the cosmetic appearance of the donor site. The final cosmetic appearance was acceptable to all patients. We conclude that the radial forearm flap is a useful, easily elevated flap, suitable for skin defects of upper and lower extremities. Major advantages of the flap are its ability to be used as an island flap and that the surgery can be performed under axillary block anaesthesia.

The posterior interosseous artery flap versus the adipofascial radial artery perforator flap in reconstruction of firecracker and homemade bomb blast injuries of the hand

“…17 The forearm is a suitable regional donor site for providing various vascularised flap options aimed at hand coverage. 18 Amongst the various possible options, the distally based radial forearm flap, the radial artery perforator flap and the posterior interosseous artery flap are the ones that allow a good reach to resurface defects predominantly affecting the radial aspect of the hand, which is the usual pattern noted in firecracker and homemade bomb blast injuries. 5 The original radial forearm flap (Chinese flap) was first used by Lin et al for hand and finger soft tissue coverage.…”

Extensor hallucis longus tendon and soft‐tissue reconstruction with palmaris longus tendon included in a radial forearm free flap: A case report

“…It has been estimated that the EHL muscle contributes 15% of the dorsiflexion strength of the ankle, and injury or surgical excision of EHL tendon without reconstruction cause hallux dysfunction and results in a flexion deformity at interphalangeal joint (Bastías et al, ; Griffiths, ; Joseph & Barhorst, ; Kessler, ; Lipscomb & Kelly, ; Park et al, ; Pedreira et al, ; Robertson, Nutton, & Keating, ; Smith & Coughlin, ; Soucacos et al, ; Taylor & Townsend, ; Thordarson & Shean, ; Wong et al, ; Zielaskowski & Pontious, ). There is no consensus in the literature regarding the ideal reconstruction of EHL tendon after oncologic resection: most of the cases reported reconstructions of acute or chronic tendon rupture.…”

“…Few reports are available addressing EHL tendon reconstruction after oncologic resection, and there is no consensus in the literature regarding the ideal technique (Bastías, Cuchacovich, Schiff, Carcuro, & Pellegrini, 2019;Joseph & Barhorst, 2012;Lipscomb & Kelly, 1955;Park, Lee, & Sim, 2003;Pedreira, Calotta, & Deune, 2019;Smith & Coughlin, 2008;Taylor & Townsend, 1979;Wong, Daniel, & Raikin, 2014;Zielaskowski & Pontious, 2002). The use of a palmaris longus tendon included in a fasciocutaneous radial forearm free flap for reconstruction of the extremities has been firstly described by Soucacos et al in 1992(Soucacos, Beris, Xenakis, Malizos, & Touliatos, 1992. In this report, we present a case of this technique used to reconstruct soft-tissue and EHL tendon of the distal foot dorsum after excision of recurrent myxoinflammatory fibroblastic sarcoma.…”

“…At latest follow-up, 12 months postoperatively, the patient showed an F I G U R E 1 After the excision of a myxoinflammatory fibroblastic sarcoma recurrence, the EHL tendon was sacrificed, leaving a 14 × 5 cm soft-tissue defect and 14-cm tendon gap. EHL, extensor hallucis longus F I G U R E 2 A 14 × 5 cm radial forearm flap with a 16-cm section of palmaris longus tendon including the investing deep fascia was harvested from the left forearm on a vascular pedicle It has been estimated that the EHL muscle contributes 15% of the dorsiflexion strength of the ankle, and injury or surgical excision of EHL tendon without reconstruction cause hallux dysfunction and results in a flexion deformity at interphalangeal joint (Bastías et al, 2019;Griffiths, 1965;Joseph & Barhorst, 2012;Kessler, 1973;Lipscomb & Kelly, 1955;Park et al, 2003;Pedreira et al, 2019;Robertson, Nutton, & Keating, 2006;Smith & Coughlin, 2008;Soucacos et al, 1992;Taylor & Townsend, 1979;Thordarson & Shean, 2005;Wong et al, 2014;Zielaskowski & Pontious, 2002). There is no consensus in the literature regarding the ideal reconstruction of EHL tendon after oncologic resection: most of the cases reported reconstructions of acute or chronic tendon rupture.…”

Surgical Approaches from an Angiosomal Perspective

“…The versatility of this pedicle and its associated composite flaps is well documented. [5][6][7][8][9] The radial artery not only supplies the voloradial aspect of the distal radius, as might seem intuitively obvious, but also the dorsal aspect of the bone via the 1,2 supraretinacular artery (1,2 SRA), and the dorsal radiocarpal arch (DRCA). The 1,2 intercompartmental artery (ICA) originates from the radial artery approximately 5 cm proximal to the radiocarpal joint.…”