Pedicled and Free Radial Forearm Flaps for Reconstruction of the Elbow, Wrist, and Hand

Author(s): Jones NF, Jarrahy R, Kaufman MR

Source: Plast Reconstr Surg 121: 887-898, 2008.

Summary:

This retrospective analysis is the largest reported series of radial forearm flaps for reconstruction of the upper extremity.  A total of 67 radial forearm flaps were performed by a single surgeon that included antegrade, retrograde, fascial, osteocutaneous, pedicled, and free radial forearm flaps for the reconstruction of the elbow, wrist, and hand.  Primary healing of soft-tissue effect was achieved in 95% of patients. 

There was one flap dehiscence, partial loss of two reverse flaps, and complete loss of one free flap.  There were no reported cases of cold intolerance or dyesthesias and patient questioning did not reveal dissatisfaction with the donor site appearance.  Based on their experience the authors conclude that the antegrade radial forearm flap is the optimal flap for the coverage of elbow defects and the reversed flap is the optimal choice for coverage the hand and wrist.

The radial forearm flap is considered one of the major workhorse flaps for soft- tissue coverage of the elbow, wrist, and hand. It is versatile because it may be transferred as an antegrade, retrograde, or free flap.  Furthermore, it can be made thin as a fascia only flap or transferred as a composite flap to include tendon or radius bone.  Additionally, the flap can be made sensate by encompassing either the medial or lateral cutaneous nerves of the forearm that can be beneficial in reconstructing palmar defects. This article nicely shows the versatility and reliability of the radial forearm flap for upper extremity soft tissue defects.  Although the patients did not report dissatisfaction with appearance of the forearm, the donor site can be a cosmetic problem, especially in younger women.