Versatility and Reliability of Radial Forearm Flaps for Upper Extremity Reconstruction

The purpose of this study was to analyze the indications for the radial forearm flap in reconstruction of the upper extremity and to document any complications with the flap or donor site.

Fifty-eight radial forearm flaps were performed for upper extremity reconstruction by a single surgeon; 47 were pedicled and 11 were free flaps from the contralateral (8) or ipsilateral extremity (3). Thirty-six pedicle flaps were designed on reverse flow in the radial artery, and 11 were based on antegrade flow. Five flaps were elevated as radial forearm fascial flaps. The flaps were indicated for soft-tissue coverage of the elbow (9), dorsal wrist and hand (21), palmar wrist and hand (8), thumb-index finger web space (11), and for coverage of thumb amputations (5). Pedicled or free radial forearm flaps were used for reconstruction after radical resection of malignant tumors of the hand or wrist in 12 patients. More esoteric indications included circumferential wrapping of the median, ulnar, and radial nerves for traction neuritis (4), after release of radio-ulnar synostosis (1), and prior to pediatric toe-to-hand transfers (2).

Transfer of the radial forearm flap and healing of the donor defect were successful in 93% of patients. There was partial flap loss of 2 pedicled flaps and complete loss of one free flap in a patient who had been heavily irradiated. One flap dehiscence occurred in a patient who began unrestricted, early mobilization. Eight donor sites were closed primarily, 46 were covered with a split-thickness skin graft. There was 100% “take” of the split-thickness skin graft on the donor defect in all 46 patients. No patients complained of cold intolerance of the hand or dysthesias in the superficial radial nerve or lateral antebrachial nerve distribution.

This is the largest reported series of radial forearm flaps for reconstruction of the upper extremity. The antegrade pedicled radial forearm flap is unquestionably the flap of choice for coverage of defects around the elbow. The reverse radial forearm flap or contralateral free radial forearm flap is more versatile than the groin flap and more reliable than the posterior interosseous artery flap for coverage of moderately sized defects of the dorsal or palmar wrist and hand. Its versatility should be considered in cases of recalcitrant carpal tunnel and cubital tunnel syndromes, for release of thumb-index finger web space contractures, and in preparation for pediatric toe-to-thumb transfers.