This case report describes the reconstruction of a soft-tissue defect of the distal forearm after resection of a fibrous histiocytoma that included exposure of the wrist flexors and resection of 7 cm of the radial artery. The patient exhibited slow flow to the hand through the remaining ulnar artery on Allen's testing, and therefore simultaneous soft-tissue coverage and arterial reconstruction was performed. Because of the thin nature of the resected tissue on the radial forearm, larger arterial flow-through flaps were felt to be undesirable.
An 8x3 cm dorsal hand flap was selected from the ipsilateral hand, based on a large dorsal vein central to the flap, and was anastomosed to the proximal and distal ends of the resected radial artery as a venous flow-through flap. No artery was contained in the flap, which was reversed to prevent valve obstruction, and no outflow veins were repaired. Although the flap became congested, and leeches were used for 4 days, 90% of the flap skin survived, and flow through the reconstructed radial artery graft was maintained. The cosmetic and functional results were excellent.
As has been shown with increasing frequency, arterialized venous flow-through flaps have great utility in reconstruction of hand defects where a combination of thin, pliable skin and minimal donor morbidity are desired. They are limited to rather small defects, however, as flaps larger than approximately 3 cm in width become ischemic due to irreversible venous congestion. In properly selected cases, such as this one, these flaps offer excellent solutions to the combined needs of soft-tissue and vascular defects in the hand.
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Journal of Reconstructive Microsurgery