Distally-Based Forearm Flow-Through Flaps for Emergency Finger Revascularization

Abstract

This paper reports the authors' experience with the use of distally-based forearm flaps as flow-through flaps for revascularization of distal parts of the hand, by simultaneous coverage of traumatic soft-tissue defects. Two clinical cases are presented and the pertinent literature is reviewed.

Flying Solo: A Single Year-Single Surgeon Community Hospital Replantation/ Revascularization Experience

“…The value of such immediate reconstruction in the management of hand trauma has been well documented. 17,18 Beside maximizing digit length, these flaps so utilized provided for one-stage primary healing in the injured hand, and thus shortened the overall recuperative phase for the patient. Without utilization of these flaps, which included the reverse radial artery fasciocutaneous flap and the dorsal metacarpal artery flap, significant shortening of the proximal digital stump would have been required to achieve wound closure.…”

Flow-through flaps: A review of current knowledge and a novel classification system

“…8 Flow-through flaps have also been used for traumatic hand reconstruction. Libermanis et al 17 used retrograde radial forearm flaps for finger revascularization and soft tissue coverage, and Brandt et al 18 describe a series of 11 patients with complex hand injuries that were reconstructed using temporoparietal, dorsalis pedis, and fillet flow-through flaps.…”

“…Simultaneous transfer of vascularized bone graft or osteocutaneous flap together with forearm flap Hallock 12 Midfoot/Lower extremity peripheral vascular disease 1 Partial failure of radial forearm flap salvaged by using surviving portion as ' 'bridge' ' flap for revascularizing second free flap (gracilis) Kasten et al 13 Upper extremity trauma 1 Burt et al 62 Mid face trauma 1 Radial forearm flaps used in flow-through manner between gracilis flaps on each side and respective facial vasculature Tseng et al 8 Foot/Lower extremity trauma 1 Lateral antebrachial cutaneous n. Anastomosed to deep peroneal n. As sensate flap Libermanis et al 17 Hand trauma 2 Distally based, retrograde, radial forearm flaps for finger revascularization and soft tissue coverage Bacakoglu et al 1 Upper extremity trauma 2 Described treating delayed venous ischemia in flow-through flap using arteriovenous anastomosis Coban et al 10 Hand infection 1 Dorsal hand injury secondary to anthrax exposure Chun and Marin 9 Forefoot/Lower extremity peripheral vascular disease 2 Radial artery flow-through flap used as vascular conduit that provides venous outflow and acts as a functional modulated arteriovenous fistula Muneuchi et al 11 Lower extremity trauma 1 Radial forearm FTF used to restore soft tissue loss after replantation of leg Teodorescu et al 6 Lower extremity peripheral vascular disease 10 Composite femoral-tibial bypass graft constructed by sewing radial forearm graft to either greater saphenous vein or polytetrafluoroethylene graft Ulnar forearm Lovie et al 22 Defect in oral cavity, lower extremity, maxilla 11 Libermanis et al 17 Hand trauma 1 One-stage recon of two rays with soft-tissue defect and associated segmental defect of metacarpals and flexor tendons, nerves and arteries Posterior interosseous Shibata et al 24 Hand trauma 3…”