Reverse Radial Forearm Fascial Flap with Radial Artery Preservation

Abstract

The reverse radial forearm fascial (RRFF) flap is widely used in soft-tissue reconstruction of the hand. The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch. In patients with an abnormal Allen test because of an incomplete palmar arch, the traditional RRFF flap is contraindicated unless a vein graft is used to reconstruct the radial artery. A simpler alternative approach for hand reconstruction in such patients is a distally based RRFF flap based on radial artery perforators, which preserves the radial artery. We used RRFF flaps based on radial artery perforators in five patients who had palmar or dorsal soft-tissue loss. All five recovered full hand function, and only one had any complications (full-thickness skin graft loss at recipient site). The RRFF flap based on distal radial artery perforators is suitable for thin coverage of soft-tissue defects in hands with either a complete or an incomplete palmar arch.

Reverse Radial Forearm Flap

“…8 It can be raised as fasciocutaneous flap, suprafascial or adiposofascial flap and provides robust tissues for soft tissue reconstruction of the hand, as it has constant anatomy, this flap also provide a better contour and avoids the necessity of having to thin the flap. 3,8 This is a resourceful flap and according to the dimensions of the defects it can be raised in different sizes. 17 Large defects can also be covered and it is documented in the literature that whole of the skin of the forearm can be raised on radial artery leaving 2cm cuff of skin on ulnar aspect dorsally.…”

“…5,8 Donor site has cosmetic and functional disadvantages, because it can only be primarily closed if the diameter of the flap is less than 3cm in size, larger defects requires skin grafting for coverage of secondary defects. 3,8 One of the most distressing complications of this flap during harvesting; is the damage of superficial sensory branch of radial nerve which can give rise to neuroma formation as well as sensory loss to anatomic snuff box area and care should be taken to avoid these problems.…”

“…The disadvantage of PIA flap is technically challenging and time consuming procedure. 3,4 Doral ulnar flap has a limited arc of rotation due to its short pedicle. 5 Distant flaps include abdominal and groin flap; but they need specific position of hand in dressing for at least 3 weeks which is cumbersome for the patient.…”

Fascial Flap Reconstruction of the Hand: A Single Surgeonʼs 30-Year Experience

“…41 Although our preference in the past has been to reconstruct radial-sided inflow to the hand following either pedicled or free tissue transfer of the radial forearm fascial flap with an interposition vein graft to limit donor-site morbidity, tech- Plastic and Reconstructive Surgery • March 2010 niques permitting preservation of the native radial system in the setting of pedicled flap harvest have recently been described. 42 Later in this series, we used less temporoparietal fascial flaps in lieu of the radial forearm fascial, which is much easier to dissect and does not require microvascular expertise. Specialized surfaces of the hand are ideally replaced with "like" tissue.…”

Paediatric hand burns

“…U nedostatku periosta ili tetivnih ovojnica u kirurškom liječenju opeklina dječje šake izbor je primjena kožnih režnjeva (13). najbliži i najčešće primjenjivani su fasciokutani ili fascijalni režanj podlaktice, koji uključuju kožu, potkožje, priležeću fasciju i septokutane perforirajuće grane radijalne ili ulnarne arterije (14).…”