Harvesting of forearm perforator flaps based on intraoperative vascular exploration: Clinical experiences and literature review

Abstract

The use of perforator flaps all over the body, as free microsurgical transfers, as well as pedicled or transposition flaps gained more and more importance in the surgery of tissue defects. When we consider harvesting such flaps at trunk level, in repeatedly traumatized areas, after previous surgery or when we plan to use the perforator flap as a free flap, it is very important to perform preoperative investigations aimed to precisely localize the perforator or perforators able to sustain such a flap. But, at limb level and, especially, at forearm level, the preoperative investigations cannot always have a complete justification. After a short review of the main preoperative investigations used in flap surgery and considering our color Doppler study, we will present in this article our technique of performing such flaps in the forearm, without any preoperative perforator vessel detection.

The Versatility of Propeller Flaps for Lower Limb Reconstruction in Patients With Peripheral Arterial Obstructive Disease

“…Additionally, the location of the perforators is predictable through preoperative Doppler flowmetry examination. Although there is consistent amount of debate concerning it's use in perforator mapping of the upper extremity, 14 we found Doppler flowmetry to be very useful in our case series. In all of our patients, the perforator found preoperatively was identified during surgery under the same spot.…”

Perforator Based Propeller Flaps in Limb Reconstructive Surgery: Clinical Application and Literature Review

“…The procedures were performed under magnification loupes (2.5–4.0x) with microsurgical instruments and technique. After skin incision, direct visualization of perforator vessels was performed by means of subfascial approach [13, 14] and the perforator vessel was chosen before flap harvesting taking into account the size of pedicle and the distance from the recipient site (Figures 1(a)-1(b)). The flap was then harvested with the rotation center situated on the emergency point of perforator artery (Figures 1(c)-1(d)).…”

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications

“…In the reversed radial forearm flap, the venous drainage is reversed, and the outflow of the flap can be obstructed by valves until the venous choke vessels open fully and drainage improves. [1][2][3]13,15 Early reports of its use identify a history of such complications. 2,[20][21][22] In a series of 14 radial forearm flaps, Matthews et al 21 emphasized that venous congestion was more marked in cases that relied on retrograde venous flow.…”

“…However, the reverse radial forearm flap is notorious for venous congestion in the immediate postoperative period. [1][2][3]13 Venous congestion should be suspected if a flap appears swollen and "dusky," or demonstrates brisk capillary refill in the early postoperative period. 14 Usually edema settles as the choke vessels open and the reverse venous drainage channels dilate and drain.…”