A Composite Neuro-Teno-Cutaneous Forearm Flap in the One-Stage Reconstruction of a Large Defect of the Soft Tissue Around The Ankle

Abstract

The vascular anatomy of the radial forearm flap, incorporating the brachioradialis and palmaris tendons together with the superficial radial nerve in 20 fresh cadavers, is described. The radial artery in the cadaveric forearm was irrigated and injected with blue latex. The number and distribution of the cutaneous branches supplying the skin, brachioradialis tendon, palmaris tendon, and superficial radial nerve, were then documented in relation to the distance from the radiocarpal joint. The radial artery was found to provide adequate blood supply to the above structures. This flap has been used as a composite neuro-teno-cutaneous flap to resurface a large defect involving tendon, nerve, and skin loss in the ankle and the foot as a one-stage procedure. This technique avoids multiple-staged operations and thus shortens the convalescent period in rehabilitation of severely traumatized limbs.

The composite anterolateral thigh flap for achilles tendon and soft tissue defect reconstruction with tendon repair by fascia with double or triple folding technique

“…Various types of free flaps have been proposed, including the muscle flap, musculocutaneous flap, fasciocutaneous flap, and perforator flap. Among these, free flaps from the upper limb, such as radial forearm flaps with the palmaris longus tendon, brachioradialis flaps with the flexor carpi radialis tendon, and lateral arm flaps with the triceps tendon, as well as some flaps from the lower limb, such as the dorsalis pedis flap with the extensor digitorum longus tendon, and the groin flap including the vascularized external oblique aponeurosis, have been used for small‐sized defects. However, these flaps lack sufficient dimension for large defects, and harvesting of the normal functioning tendon for the reconstruction increases donor site morbidity.…”

The Forearm Flap - Indications, Appropriate Selection, Complications and Functional Outcome

“…The defect at the recipient site was covered with a splitthickness graft. Finally, tendons and muscles were included in the transplant as well (Cavanagh et al, 1991). To improve the donor site morbidity, Webster and Robinson (1995) as well as S.C. Chang et al (1996) described a suprafascial raised forearm flap in the 1990s but there were no differences demonstrable concerning the sensory outcome.…”

Recent advances in the reconstruction of complex Achilles tendon defects

“…18 Other radial forearm composite flaps included the tendons of the brachioradialis and palmaris longus, as well as the superficial radial nerve. 37,38 Reconstruction in these flaps sometimes required an interpositional vein and nerve graft. Advantages of the forearm flap include a moderately large area of donor skin, a long pedicle of relatively good caliber and consistent anatomy, and a thin subcutaneous layer of fat that can provide a contour similar to the normal lower leg.…”