Innervated radial thenar flap combined with radial forearm flap transfer for thumb reconstruction

A radial thenar flap combined with radial forearm flap was used for the reconstruction of the ipsilateral thumb in four patients. Vascular supply of the combined flap was based on the radial artery and extending the vascular pedicle to the superficial palmar branch of the radial artery. The flap was sensated by the palmar branch of the superficial radial nerve. The size of the flap averaged 15 x 5 cm and the innervated region of the thenar eminence was an area approximately 5 x 3 cm located over the proximal parts of the abductor pollicis brevis and opponens pollicis muscles. The flap was transferred as a free flap in three patients and as an advancement flap in one patient. The flaps survived completely without complications. Satisfactory restoration of sensation was achieved in the flap area, as shown by 6 mm of average moving two-point discrimination. This combined flap may be a feasible reconstructive option for large palmar defects of the fingers such as degloving injuries.     

The radial forearm flap for reconstruction of the upper extremity

The radial forearm flap, owing to its good-caliber arteries of long length and equally well distributed venous system, has proved very reliable. It has not only earned its place and recognition in reconstructive hand surgery, but also has emerged as a workhorse for the microvascular surgeon. We have used 14 radial forearm flaps for upper extremity reconstruction, and we present herein our experience. The technique of extracorporeal tissue transfer, which has been published elsewhere, was used in two patients and is detailed. Four representative patients are presented.     

Simultaneous bilateral foot reconstruction using a single radial forearm flap

The radial forearm septocutaneous flap is an excellent source of thin tissue with an anatomically consistent network of large vessels that simplify microsurgical transfer. It may be divided into multiple flaps leaving a single donor-site defect. The clinical usefulness of this concept is demonstrated in a single case in which simultaneous coverage of electrical burns of both feet was required.     

Conjunctival cul-de-sac reconstruction with radial forearm free flap in anophthalmic orbit syndrome

Contracted eye socket is a constant cosmetic embarrassment to the patient. It not only renders patients unable to maintain an eye prosthesis, but it becomes a source of chronic discharge and irritation. Eye socket reconstruction with free skin, mucous membrane, cartilage, or dermis-fat usually remains unsatisfactory in many cases, due to secondary graft contracture. Traumatic injuries to the orbit and neighboring soft tissue frequently lead to a contracted eye socket. This condition results from the need for removal of the traumatized conjunctiva at the time of the enucleation, along with the traumatized eyeball, for satisfactory wound closure. In traumatic anophthalmos patients, a radial forearm free flap was used for conjunctival cul-de-sac reconstruction. Eye socket beds were developed as hinge-shaped flaps and used as lining for the upper and lower palpebrae. The authors conclude that the radial forearm flap is a useful alternative in the treatment of traumatic anophthalmos.     

The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases

Sixty consecutive patients in whom a free radial forearm flap was used to reconstruct an intraoral defect have been reviewed. The ages ranged from 54 to 85 years, the majority of patients presenting with intraoral carcinoma. There were 6 microvascular failures, and the remaining 54 patients (90 percent) healed uneventfully, with no incidence of fistula. Intraoral healing time was reduced to 11 days on average, and hospitalization was similarly reduced to 17.8 days. A slower postoperative recovery did not appear to be related to age or to the site of the defect within the oral cavity but closely paralleled the extent of excisional surgery. The postoperative mortality was less than 2 percent, but the overall prognosis remained poor, with a 21.6 percent mortality at follow-up (minimum 15 months). Thirty-nine patients (72 percent) underwent early postoperative radical radiotherapy without any evidence of intraoral wound breakdown or problems with flap viability. The results demonstrate the effectiveness of this method of intraoral reconstruction and indicate that such complicated and prolonged surgical techniques do not increase the risks associated with major head and neck surgery.     

A comparison of the results following oromandibular reconstruction using a radial forearm flap with either radial bone or a reconstruction plate

Fifteen cases of oromandibular reconstruction using a radial osteocutaneous flap were compared with 16 in which the mandible was replaced with a reconstruction plate and a forearm flap was used for intraoral lining. All cases involved oral cancer; most had been irradiated. Nine survived in each group. Complications included one infected nonunion in addition to two bone exposures in the bone group, compared with three cases of plate exposure and two bone exposures in the plate group. Functional results were similar in both, but osteointegrated implants were possible only in the patients receiving bone. Cosmesis seemed somewhat better in the plate group. Donor-site problems were common but minor, and long-term forearm function was slightly reduced in both groups. Although the sample sizes were small, the reconstruction plate together with a radial forearm flap appeared to provide effective reconstruction following composite resection. However, we would not recommend this for the younger patient or in benign disease.     

Comparison of the radial forearm flap and the thinned anterolateral thigh cutaneous flap for reconstruction of tongue defects: an evaluation of donor-site morbidity

The radial forearm flap is commonly used for reconstruction of tongue defects following tumor extirpation. This flap is easy to harvest and offers thin tissue with large-caliber vessels. However, its use leaves behind a conspicuous aesthetic deformity in the forearm and requires the sacrifice of a major artery of that limb, the radial artery. The anterolateral thigh cutaneous flap has found clinical applications in the reconstruction of soft-tissue defects requiring thin tissue. More recently, in a thinned form, the anterolateral thigh flap has been used for reconstructing defects of the tongue with functional results equivalent to that of the radial forearm flap. For the reconstruction of tongue defects, these two flaps could provide similar soft-tissue coverage, but they seem to result in different donor-site appearances. The donor site is closed primarily, leaving only a linear scar that is inconspicuous with normal clothing, and no functional deficit is left behind in the thigh. Thus, for the supply of flaps for tongue defects, a comparison between the radial forearm flap and the anterolateral thigh flap donor sites is provided in this study. Between December of 2000 and August of 2002, 41 patients who underwent reconstruction of defects of the tongue using either a radial forearm flap or an anterolateral thigh flap were evaluated. The focus was on the evaluation of the functional and aesthetic outcome of the donor site after harvesting these flaps for the purpose of reconstructing either total or partial tongue defects. Finally, a comparison was performed between the donor sites of the two flaps. The disadvantages of the radial forearm flap include the conspicuous unattractive scar in the forearm region, pain, numbness, and the sacrifice of a major artery of the limb. In some patients, the donor-site scar of the forearm acted as a social stigma, preventing these patients from leading a normal life. In contrast, the anterolateral thigh cutaneous flap, after thinning, achieved the same results in reconstructing defects of the tongue without the associated donor-site morbidity. Most importantly, the donor site in the thigh could be closed primarily in almost all patients without any functional deficit. The thinned anterolateral thigh cutaneous flap is a viable substitute for the radial forearm flap when reconstructing defects of the tongue. The results achieved are similar to those of the radial forearm flap, and the donor-site morbidity is significantly decreased.     

Osteoradionecrosis of the olecranon: treatment by radial forearm flap

Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity.     

Use of the radial forearm flap for deep,central, midfacial defects

Six cases that required soft-tissue replacement in the central midface are presented. The greatest number of flaps were used for large defects in patients with cleft palates who had undergone multiple previous operations. Several were for palatal defects attributable to cocaine abuse, and one was used for lining in a nasal reconstruction. There were no flap losses and, on the basis of these experiences, it is concluded that this is an excellent method for providing soft tissue in these difficult situations.     

Upper limb salvage using a free radial forearm flap

Microsurgical transfer of a skin flap salvaged from a nonreplantable upper extremity that would otherwise be discarded may provide essential soft-tissue coverage of the amputation stump, so maintaining a functional range of motion in the elbow joint. A radial forearm free flap measuring 24 cm long by 9 cm wide was salvaged from the degloved forearm skin of a patient who sustained a proximal forearm amputation that was considered unsuitable for replantation. This allowed coverage of the proximal radius and ulna, preservation of a functional elbow joint, and successful fitting of a below-elbow prosthesis.