|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Lateral Arm Fascio-Cutaneous Flap. This flap is based on the posterior radial collateral artery (PRCA), a branch of the brachial artery. The vascular anatomy of the upper arm is relatively constant and arteriograms are not indicated in healthy, nontraumatized patients. Because of the problems differentiating the PRCA from the brachial artery, the Doppler is difficult to perform.
Radial Forearm Flap. This is based on the radial artery, and again the arterial supply is relatively constant. Arteriograms and the Doppler are helpful, however, if the flap is to be harvested from a previously traumatized arm. Allen's tests should be performed to determine if adequate collateral flow to the hand is present through the ulnar artery. If not, the radial artery must be reconstituted with a reversed vein graft.
Deep Circumflex Iliac Arterial Flaps. These are very useful osseous or osteocutaneous flaps of the ilium and the overlying skin. Both arteriogram and Doppler are often indicated in this donor site owing to the significant variability of the vascular anatomy. The Doppler determines if the blood flow through the deep circumflex iliac artery is adequate, or if a shunt from the deep circumflex iliac artery to the superficial epigastric artery will be required to augment blood supply to the skin. Intraoperatively, the deep circulation is temporarily clamped while the superficial signal is monitored.
Groin Flap. This cutaneous flap has become less popular because of the variability of the vascular anatomy. The arteriogram is not useful because the superficial circumflex iliac artery can rarely be seen. Doppler is the best preoperative analysis, but unfortunately it does not assess the vessel diameter. Intraoperative evaluation is often the only means of assessing the flap's vascular anatomy.
Rectus Abdominis, Gracilis, and Tensor Fascia Lata Flaps. These have reliable vascular anatomies and require neither Doppler nor arteriogram.
Fibular Osteo or Osteocutaneous Flaps. These flaps, based on the peroneal artery, are frequently used for bony reconstruction. The peroneal artery is too deep for accurate Doppler assessment. Because the vascular anatomy of the leg is relatively constant, an arteriogram is not indicated.
Dorsalis Pedis. This is based on the anterior tibial and dorsalis pedis arteries. If the Doppler is inconclusive, an arteriogram should be performed.
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