Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 14:
The Radial Forearm Flap
  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.

Operative Sequence


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.

B. The elevation of the flap is generally begun on the ulnar aspect of the flap and continues toward the radial pedicle. The antebrachial fascia is incised and elevated with the skin paddle. Major vessels to the skin travel in the antebrachial fascia first, and multiple branches to the skin arise from this facial plexus. The skin paddle does not necessarily overlie the radial vessels; the skin and vessels require only fascial continuity between them to ensure adequate vascularity. The proximal forearm skin is elevated to expose and preserve the superficial vein previously marked. The antebrachial fossa is incised and sutured to the skin edge of the flap to prevent shearing.

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