Island Adipofascial Flap Based on Distal Perforators of the Radial Artery: An Anatomic and Clinical Investigation

Abstract

Reconstruction of soft-tissue defects of the hand with exposed tendons, joints, and bone represents a challenge to the plastic surgeon, and such defects necessitate flap coverage to preserve hand function and to protect its vital structures. Reported here is the study of an island adipofascial flap based solely on the distal five to eight septocutaneous perforators of the radial artery and their venae comitantes. Designing the flap in the form of an island with skeletonization of the distal perforators of the radial artery ensures its vascular pattern from these perforators alone with no connection to the ulnar artery perforators or posterior interosseous artery perforators, as is the case with fascial pedicled flaps. Furthermore, designing the flap as an island facilitates the arc of rotation and avoids the pedicle kink when the flap is turned 180 degrees. Preservation of the radial artery, as well as the mild thickness of the flap are further advantages. The drawbacks of such a flap include temporary impaired sensation at the donor site, the obvious scar in the forearm, and loss of hair. Eleven fresh and fixed cadaver upper extremities were dissected to delineate the vascular pattern and to define the arc of rotation of the flap. Also, a clinical approach was conducted on two patients who sustained extension scar contracture with tendon adhesions of the dorsum of the hands, on two patients who sustained first web space contracture, and on two patients who had full-thickness soft-tissue loss over the palm; and finally on two patients who sustained traumatic soft-tissue loss over the dorsum of their hands with exposed tendons and metacarpal bones.

Reversed Forearm Island Flap Supplied by the Septocutaneous Perforator of the Radial Artery: Anatomical Basis and Clinical Applications

“…Distally based fasciocutaneous flaps based on a subcutaneous pedicle including the cephalic vein and the lateral antebrachial cutaneous nerve and supplied distally by the perforators from the radial artery have been reported. [12][13][14][15] However, few studies have clearly demonstrated the finer framework of the vascular connections among these perforators within the integument itself, which determines the vascular anatomical basis and which is critical for the survival of any flap based on these perforators. The exact vascular territory of the distally based island flap remains unclear.…”

Distal radial and ulnar arteries perforator‐based adipofascial flaps for covering hand traumatic defects

“…3,5 The principle of flap vascular supply via perforators can be applied in the radial-forearm flap.…”

“…The reversed ulnar forearm flap described by Lovie is a septocutaneous flap [1][2][3][4][5] based on the septocutaneous perforators of the ulnar artery, but it can also be harvested as a fascial flap. 2 The use of the fascial flap is indicated in patients with soft tissue defects of the hand.…”

“…They used this flap to pad and protect the median nerve, to provide a gliding surface for tendon transfer, and to separate the fresh-cut surfaces of and ulna-radius synostosis. In 1997, El-Khatib and Zeidan 30 published a study citing their experience on eight cases using an island adipofascial flap based on distal perforators of the radial artery located 2-7 cm from the radialstyloid process. In 1998, Jeng and Wei 31 reported their experience on 12 cases using the distally based radial forearm flap for hand reconstruction.…”

Distally based radial forearm flap with preservation of the radial artery: Anatomic, experimental, and clinical studies

“…21 Therefore, neurofasciocutaneous flaps or neurovenofasciocutaneous flaps may be more suitable terms. 22 In 1997, El-Khatib and Zeidan 23 introduced an anatomic study and 8 cases using an island adipofascial flap based on distal perforators of the radial artery located between 2À7 cm from the radial styloid process.…”