The Transverse Radial Artery Forearm Flap Hee Chang Ahn, M.D., Ph.D. et al. Seoul, Korea

radial forearm flap Disadvantages: delayed healing of donor site need for a skin graft unsightly scars limited wrist motion

new design closure of the donor defect by V-Y advancement of a fasciocutaneous flap, which is based on the ulnar artery minimizes donor-site morbidity improves the aesthetic result The skin paddle of the transverse radial artery forearm flap is designed as an ellipse, with the long axis lying transversely

As a composite flap, any segment of the radius can be harvested The pedicle is easily accessed and is longer than in the conventional forearm flap As a composite flap, any segment of the radius can be harvested more liberal insetting subcutaneous tissue contains cutaneous nerves for use as a sensate flap medial or lateral antebrachial cutaneous nerves

Technique radial and ulnar artery competency Allen’s test Doppler ultrasound The flap is designed as an ellipse, with its center located over the pedicle distal side of the flap extends to the wrist crease and its axis parallels the wrist crease The pedicle is identified and ligated at the distal end The flap is then elevated, beginning at its radial end

The radial artery and its venae comitantes are identified and dissected proximally to the necessary length. A comitant vein is usually used for venous drainage. The inclusion of the cephalic vein in the flap is optional. If an osteocutaneous flap is needed, a piece of radial bone from any level of the radius can be included.

To close the donor defect V-shaped fasciocutaneous flap based on the ulnar vessels is elevated on the forearm 8 cm of the ulnar skin of the V is left intact the nerves and veins are subcutaneously released for approximately 4 cm in both proximal and distal directions distally and slightly ulnarly rotated wrist joint is flexed for approximately 10 days physical therapy for 4 weeks

Discussion Hairless skin Thin skin Long vascular pedicle Sensate if needed Can be used as a composite flap The bone can be set independently Donor site morbidity reduced