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

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

3. 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

4. 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

5. 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

6. 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.

7. 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

17. 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