Suprafascial compared with subfascial harvest of the radial forearm flap: an anatomic study

PURPOSE: Inclusion of the deep fascia within the radial forearm flap is conventionally thought to be essential for flap viability. Angiography and dissection studies were used in this study to elucidate the role of the deep fascia in perfusion of the radial forearm flap. METHODS: Twenty-four radial forearm flaps were harvested from 12 fresh cadavers. Ten paired suprafascial and subfascial flaps were harvested, the radial arteries were cannulated, and methylene blue dye was injected into the radial artery followed by a barium sulfate/gelatin mixture. The flaps were digitally radiographed, and the vascular territory was measured using software. The cutaneous dye staining patterns for paired flaps were recorded photographically. Computed tomography scans were performed for 3 paired flaps to evaluate the vascular pattern within the flap. Two pairs of forearms were subjected to intravascular injection with colored latex through the brachial artery prior to flap harvest, and microdissection of the flap and fascia was performed. RESULTS: No significant difference was found in the vascular territory measured for the flap when harvested using the subfascial or the suprafascial technique. Flap dissection studies confirmed that this is because of the poorly developed subfascial plexus in the forearm, with preservation of the deep fascia not contributing to the mechanism of flap perfusion. CONCLUSIONS: Inclusion of the deep fascia during flap harvest does not contribute to the perfusion of the radial forearm flap and therefore the deep fascia does not need to be included to maintain flap vascularity.