Shape Modified Radial Artery Perforator Flap
Roberto Adani, MD; Giovanna Petrella, MD; Martina Rocchi, MD
Modena University, Modena, Italy
The radial forearm flap is one of the most reliable conventional type of flaps.This is due to its thinness, pliability, good vascularization, relative hairlessness and good sensation that are suitable for various kind of surgical reconstruction.The disadvantages lies in radial artery sacrifice and donor-site morbidity.
The increasing anatomical knowledge has allowed to carefully identify the perforating vessels starting from the radial artery and to subdivide the radial flap into two or three components according to the course of such perforators. This allows to fit a wide range of differently shaped recipient sites and permit the donor side to close primarily without any problems.
MATERIALS AND METHODS
From 2014 to 2016, 5 patients were treated by "shape-modified radial artery perforator flap". There were 4 men and a woman. Free flaps from the contralateral limb were used in 2 cases and pedicled flaps were used in 3 cases. The age of the patients ranged from 7 to 52 years. The reconstructed areas involved in 4 cases the hand and in one case the elbow. The donor site was primarily closed in three cases, in the remaining two, the donor site was initially protected with Integra and after three weeks covered with a thin dermal epithelial graft. The cause of injury had a traumatic origin in all cases.
All the flaps survived. We did not find any cases of necrosis, including marginal ones. Moreover, donor site morbidity was evaluated: very good results were highlighted when donor site closed directly, satisfactory results, instead, when it recovered in two steps. There were no cases of impaired blood circulation of the hand or cold intolerance after sacrifice of the radial artery.
Despite the limited number of patients, the method is not a demanding procedure and it is well adaptable to the various reconstructed areas (fingers, first web space, dorsum of the hand, and elbow). The flap can be considered an alternative safe method to other reconstructive techniques especially when reconstruction has to match the concept of "like to like". Anyway, a longer follow-up should definitively confirm the central role of this reconstructive technique.
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