|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| 4. When the radius is used in the flap, radial fracture is a well-recognized complication. Approximately 20% of patients (Soutar: personal communication) who have a segment of the radius removed subsequently fracture their radius. We have found this most common in postmenopausal women. Postoperative immobilization to protect the radius against fracture varies from 6 weeks to 3 months.
5. In the early postoperative period, failure of complete skin-graft take, leaving exposed tendons, may be a problem. This is uncommon if paratenon is preserved, and generally these areas granulate and epithelialize spontaneously with proper wound care.12,18,20,21
6. Herniation of muscle through antebrachial fascia may produce a bulge in the forearm postoperatively. This cosmetic deformity tends to occur when the dissection has been confined to a small part of the length of the forearm, leaving a significant amount of undivided fascia.
PLATE XIV-1. Anatomy
A. The recipient defect is created or defined, and a pattern of the defect is transferred to an appropriate position on the forearm. Usually, the flexor surface on the ulnar aspect where hair growth is less dense is best, especially for intraoral reconstruction. In most patients, the nondominant forearm is also the preferred donor arm. An Allen's test should be done preoperatively. Because the dissection attempts to incorporate at least one superficial forearm vein to drain the skin flap, the superficial venous system proximal to the skin paddle is outlined.
A. With the tourniquet inflated, the dissection begins over the proximal forearm to expose the radial artery and its venae comitantes, paralleling and deep to the brachioradialis muscle proximally and superficial to the pronator.
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