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

Ciuman, Raphael Richard; Dost, Philip

doi:10.5772/34383

Cited by 3 publications

(6 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12,15 Hülsbergen-Krüger et al, described in their group of 267 patients after closing the defect with split-thickness graft, reduced pigmentation in 43.4%, increased pigmentation in 15%, level differences >0.1cm in 46.8%, but in only 12% >0.4cm, an unstable scar in 10.5% and an adherence of the defect in 18.7%. 16 Adequate compression, first with dressings and later with compression stockings, and the application of 2 mm metal plates can assist the wound healing.…”

Section: A B Cmentioning

confidence: 99%

“…16 Adequate compression, first with dressings and later with compression stockings, and the application of 2 mm metal plates can assist the wound healing. 12,16 The most utilized technique to close the defect at the donor site is the coverage with 0.2-0.6mm split-thickness skin grafts. Lutz and colleagues described a success rate of 98% compared with 84% in full skin grafts.…”

Section: A B Cmentioning

confidence: 99%

“…Dehiscence after expansion was described in up to 40%, 14,21 but other studies showed complication rates of less than 10%. 3,12 Important anatomical variations in regards with the free forearm flap transfer were reported and should be described briefly. The raised forearm flap area should not extend beyond the antecubital fossa and the radial or ulnar borders to avoid complications and sensory impairment.…”

Section: A B Cmentioning

confidence: 99%

“…Radial or ulnar artery dominance can be a hint for presence of a superficial ulnar artery or median artery, which can be used for elevation instead of the dominant artery. 12,28 The venous drainage of the forearm is guaranteed equally by the subcutaneous veins and the venae commitantes. Consequently, the subcutaneous veins can be preserved or serve for a vein graft.…”

Section: A B Cmentioning

confidence: 99%

“…A transplant based on the deep venous system shows advantages in older patients and avoids the risk provided by veins venipuncture a few days or weeks ago and facilitates the prevention of cutaneous nerve damage. 12,20 The superficial venous system shows high variety in size, dominance and course. Numerous anastomoses exist between the superficial veins, the deep veins and the deep and superficial venous system.…”

Section: A B Cmentioning

confidence: 99%

See 4 more Smart Citations

Chinese forearm flap technique in thumb injury: a case report

2018

View full text Add to dashboard Cite

Hand injuries which involve substantial skin loss require immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. In 1978, Dr. Yang Guofan and Dr. Chen Baoqui described a flap from the forearm based on the radial artery or Chinese Forearm Flap. A 30-year-old male was admitted to the emergency room because of crush injury. From physical examination we found crush injuries of left hand followed with open wound between 1st and 2nd finger at dorsal and palmar side with muscle, tendon, and bone exposed, with open dislocation left 1st carpometacarpal joint, open fracture dislocation left 1st metacarpophalank joint, open fracture Left Base 2nd, 4th metacarpal, open dislocation 3rd base metacarpal, open fracture left trapezoid, open left trapezium. Soft tissue injuries of the hand which require flap cover pose a problem mainly because of the apparent lack of availability of local tissue. Wound healing problems can result in an impaired functional outcome. For complication, initially, sensory disturbances can be found in 17-75% but decrease during the next months. This radial forearm flap method of post-traumatic thumb reconstruction nowadays doesn’t require expert microsurgical knowledge, which is indispensable in case of replantation or revascularization of the amputated thumb. Correct planning and elevation presupposed the flap success rates average at least 90% with no relevant limitations in strength, motion and hemodynamics in the forearm or hand and non-disturbing sensory and cosmetic outcome at the donor site.

show abstract

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

See 3 more Smart Citations

Chinese forearm flap technique in thumb injury: a case report

2018

View full text Add to dashboard Cite

show abstract

Vascular analysis of radial artery perforator flaps

Sham¹,

Masia²,

Reddy

2018

Ann Maxillofac Surg

View full text Add to dashboard Cite

Background:Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction in head & neck. Although there are several advantages, it requires the sacrifice of a major artery of forearm. There are several modifications of harvesting a forearm flap based on perforator principles. A clear understanding of vascular anatomy of individual perforators relative to its vascular territory & flow characteristics is essential for both flap harvest & design. The purpose of this cadaveric observational anatomical study was to determine the location, size & vascular territory of the radial artery cutaneous perforators.Materials and Methods:12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the total number, location, size & vascular territory of radial artery adipo-fascio cutaneous perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram.Results:In the 12 fresh human cadavers & 24 forearm specimens, a total of 222 perforators were dissected for an average of 18.5 radial artery perforators per forearm. Of the total 222 perforators dissected 118 were smaller than 0.5mm in diameter (53.15%) these were not clinically significant. 104 perforators were greater than 0.5mm in diameter (46.84%) these were clinically significant. Of the 222 radial artery perforators dissected, 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. A total of 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators on radial side was 10.6 & 7.9 on ulnar side, a comparison of both using student t paired test gives a P value of 0.006, which was statistically significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0, Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean Diameter of perforators between the Distal side (1.11) & Proximal side (0.86) using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which were more than 1mm (80%) & less than 1mm (20%) & on proximal side more than 1mm (35.6%) & less than 1mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1& P value of <0.001 was achieved which was found to be highly significant. Methylene blue injections into the proximal part of radial artery demonstrated clusters both in proximal & distal forearm & also cutaneous territory of flap. Three- dimensional computed tomographic angiography reveals a network of linking vessels found to communicate between adjacent perforators & running parallel to radial artery. Large network of linking vessels could be found between fascia & dermis, which also explains the ability to harvest for...

show abstract

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators & Its Clinical Applications in Head & Neck Reconstruction

Sham¹,

Masia²,

Reddy³

2018

IJOHNS

View full text Add to dashboard Cite

Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.

show abstract

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

Cited by 3 publications

References 67 publications

Chinese forearm flap technique in thumb injury: a case report

Chinese forearm flap technique in thumb injury: a case report

Vascular analysis of radial artery perforator flaps

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators & Its Clinical Applications in Head & Neck Reconstruction

Contact Info

Product

Resources

About

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

Cited by 3 publications

References 67 publications

Chinese forearm flap technique in thumb injury: a case report

Chinese forearm flap technique in thumb injury: a case report

Vascular analysis of radial artery perforator flaps

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators &amp; Its Clinical Applications in Head &amp; Neck Reconstruction

Contact Info

Product

Resources

About

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators & Its Clinical Applications in Head & Neck Reconstruction