Reversed radial forearm flap: an ad hoc flap for hand reconstruction

Complex wounds of the hand and vital structures are important to reconstruct. They should be covered as soon as possible in order to maintain the function of the hand. The reversed radial forearm flap is a versatile option for hand reconstruction. Reversed radial forearm flaps were harvested in 15 cases. Doppler ultrasound was used in all cases to evaluate the vascular status of the flap. No complications were observed in this series. All skin grafts healed well. The reversed radial forearm flap is a workhorse tool for the coverage of the hand.     

Reverse radial forearm fascial flap for soft tissue coverage of hand and forearm wounds

Six patients with severe hand and forearm injuries involving open wounds and exposed structures were treated with reverse radial forearm fascial flaps and split-thickness skin grafts for soft tissue cover. There were five men and one woman aged between 16 and 36 years. Injuries included soft tissue avulsion on the dorsum of the hand and fingers, extensive flexor and extensor tendon damage, multiple phalangeal fractures, a grade IIIB open dislocation of the index to little carpometacarpal joints, a grade III open metacarpal fracture and a finger amputation. The average wound size was 9 cm in length and 7 cm in width. The mean duration of follow-up was 12 months (range, 5-20 months). All flaps healed well, and all patients were satisfied.     

The free fascial forearm flap

The unpleasant appearance of the donor site after harvesting a forearm flap limits its use in many centers. In this paper, the author records his experience with a modification of the standard fasciocutaneous forearm flap. Such modification involves the utilization of the fascial component of the flap sparing the skin of the forearm, which is closed as a longitudinal line. This fascial forearm flap (FFF) was used as a free flap in eight cases. All the flaps survived well, and the donor site appearance was excellent. The fascial forearm flap advantages and limitations are discussed with recommendations for further utilization of other fascial flaps.     

Experience with the island radial forearm flap in local hand coverage

Use of the island radial forearm flap (RFF) for soft-tissue coverage of hand and forearm following mutilating injuries, chemotherapeutic injection sloughs, and tumor excisions are discussed. Twenty-eight flaps were used in 28 injured upper extremities. Partial flap loss occurred in three patients. Minor sloughing of the skin graft of the donor site occurred in four. Twelve patients had persistent dysesthesias and paresthesias in the injured extremity. All patients complained of some degree of weakness in the injured extremity. Our experience supports the use of this flap for local hand and forearm coverage when local tissue is unavailable and skin grafting is deemed inadvisable. Donor site problems have been acceptable in our patient population.     

The radial forearm island flap in early reconstruction of a severely burned hand

The radial forearm island flap has been shown to give a reliable one stage reconstruction in upper limb trauma, providing thin pliable, and when required, innervated full thickness skin cover. We present one case which demonstrates the use of this versatile flap in early reconstruction of a severely burned hand.     

Posterior interosseous island forearm flap

The skin of the dorsal aspect of the forearm is supplied by several cutaneous branches of the posterior interosseous artery. This vascular anatomy permits the surgeon to obtain an island flap of the dorsal forearm based on the distal anastomosis between the two interosseous arteries at the distal part of the interosseous space. This flap can reliably be transferred to different skin defects of the hand such as those created by correction of an adduction contracture of the first web space, or on the back or front of the wrist level. Its principal advantages are that it is a thin flap with excellent circulation and that it is possible to close the donor area primarily provided the island flap is not wider than 3 to 4 cm. The procedure has been employed in 25 patients with satisfactory results.     

Free temporoparietal fascial flap for coverage of a large palmar forearm wound after hand replantation

A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.     

A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap

The Chinese forearm flap based on the radial artery is extremely versatile. It can be used as an island-skin flap, a free flap or as a compound forearm flap including vascularised nerve, bone or tendons. This paper describes and discusses some of these applications and is based on a series of 17 patients who presented with problems of reconstruction in the hand.     

Free and island flap transfer for soft tissue defects in the hand and forearm

Two hundred twenty patients with soft tissue defects in the hand and forearm were treated with 226 free and island flap transfers. Reconstructed sites involved the thumb in 74 cases, the fingers in 117, the hand in 30, and the forearm in 5. Seventy-nine patients received 82 free flaps, and 141 patients received 144 island flaps. Fifty-six finger reconstruction cases and 73 of 74 thumb reconstruction cases had sensory flap transfers. In the free flap transfer group, 77 flaps survived (93.9%), and 5 failed. In the island flap transfer group, 140 flaps survived (97.2%), and 4 failed. Of the five-failures in the free flap transfers, four were dorsalis pedis flaps, two of which were on patients with an arteriovenous fistula. Of the four failures in the island flap transfers, two were posterior interosseous flaps and two were digital island flaps. All four were reverse-flow island flaps. © 1996 Wiley-Liss, Inc.     

Reversed saphenous fasciocutaneous island flap in marjolin's ulcers

BACKGROUND: The reconstruction of the heel represents a challenge due to the limited local soft tissue availability and also due to the special structural and functional characteristics of this region. A great number of possibilities have been described; we represent a new flap for heel reconstruction which is a modified form of sural fasciocutaneous flap. METHODS: Ten patients (two female and eight male; median age 68 years, range 48-76) underwent reversed saphenous fasciocutaneous island flap after wide excision of heel lesion. The causes of heel lesions in all patients were Squamous Cell Carcinoma on the chronic burn's scar. In this new technique, sural nerve and artery were saved and blood supply to flap is based on lesser saphenous vein. Mean lesion surface was 60 cm(2) (range 30-112 cm(2)). RESULTS: Epidermolysis and flap discoloration were seen in three patients but treated with intermittent wet dressing and conservative managements. One patient showed partial necrosis in flap circumference which recovered with debridment and skin graft. Total flap necrosis was not seen in any patients. Mean hospital stay was 10 days (range 8-15 days). The mean follow up was 12 months (rang 6-18 months). CONCLUSION: Reversed saphenous fasciocutaneous island flap is an option for heel reconstruction. In contrast with sural flap, sural nerve and artery are saved.     

Tendon ulnar artery island flap in hand surgery: Technique,indications

Summary Hand surgeons have long sought ways of avoiding adhesions in tendon repairs. The authors report on a new tendon transfer technique which is inspired by the flap based on the ulnar artery and the flexor digitorum sublimis and which ensures perfect vascularisation, good mobility and a favorable environment for suturing.Delivered at the Annual Conference of the Group for the Advancement of Microsurgery (G.A.M.), Nancy, France 1986 Offprint requests to: J.C. Guimberteau, 29 Cours de Verdun, F-33000 Bordeaux     

前臂岛状皮(骨)瓣治疗手部软组织和骨缺损

手部构造复杂，功能特殊，手部皮肤软组织缺损十分常见，治疗较为棘手。自1986年采用前臂岛状皮(骨)瓣治疗手部软组织和骨缺损161例(168手)，效果满意，报告如下。     

Versatility of the island forearm flap in the management of extensive skin defects of the hand

SUMMARY: Even the most meticulously performed reconstructions of the hand are at risk of failure if appropriate soft tissue coverage has not been ensured. The radial forearm flap has been found useful in various applications involving soft tissue coverage of skin defects not only of the upper and lower extremities, but in other plastic reconstructive procedures as well. Most hand and microsurgeons will agree that the island radial forearm flap offers several important advantages for covering defects in the hand. The versatility of this flap offers valuable options for the surgeon as it may include bone, nerve or tendons to be used as a complex flap. Its reliability is attributed to the fact that since no anastomosis of vessels is required, the risk of thrombus formation at the anastomosis site is eliminated.