The arterialised saphenous venous flow‐through flap for managing the radial forearm free flap donor site

Abstract

Background The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. Method A cohort study of six patients (five male, one female; mean age 59 [range 19–90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra‐flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. Results In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6–15 cm (mean 11.5 cm) and widths of 4–6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24–90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow‐up of 6 months (4–24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. Conclusion The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.

Coverage of radial forearm free flap donor site defect using another free flap

“…Nonetheless, due to the above drawbacks, routine application of this method may be limited and could result in over-treatment. However, considering that the application of this method could provide reliable and aesthetically satisfactory outcomes, as shown in the previous studies (Hughes et al, 2022;Rieger et al, 2016), and the current one, selective use of domino flaps may be considered for cases with extensively large and/or deep defects resulting from the harvest of RFFF. Also the original intension of this report was not to demonstrate that this method is superior to previous approaches, but to suggest that it could be considered as an efficient alternative option for the selective cases.…”

“…The present report evaluated the clinical efficacy of domino flaps for coverage of radial forearm free flap donor site defects in a case series. There have been several pioneering works adopting the concept of using domino flaps for coverage of RFFF donor sites with the use of free groin flaps (Rieger et al, 2016), or arterialized saphenous venous flow‐through flaps (Hughes et al, 2022). One distinguishing point of our report compared to those previous ones would be that we used perforator flaps (ALT and SCIP flaps), which has been known to have relatively lower donor morbidities compared to other types of flaps.…”

“…There have been several pioneering works adopting the concept of using domino flaps for coverage of RFFF donor sites with the use of free groin flaps (Rieger et al, 2016), or arterialized saphenous venous flow-through flaps (Hughes et al, 2022). One distinguishing point of our report compared to those previous ones would be that we used perforator flaps (ALT and SCIP flaps), which has been known…”

Comparison of the outcomes of split thickness skin graft versus full thickness skin graft for closure of the radial forearm free flap donor site: A systematic review

“…Complications were low and patients were satisfied with the results (Lee & Lee, 2023). A study by Hughes et al (2022) details success with six successful saphenous flows through flaps, which give the benefit of reconstructing the radial artery. Use of a free flap to repair the donor site may prove to be successful in some instances, but still, the increased surgical time and donor site morbidity must be considered.…”