A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap

doi:10.1016/0007-1226(84)90001-8

British Journal of Plastic Surgery

Volume 37, Issue 2, April 1984, Pages 139-148

https://doi.org/10.1016/0007-1226(84)90001-8 Get rights and content

Abstract

The Chinese forearm flap based on the radial artery is extremely versatile. It can be used as an island-skin flap, a free flap or as a compound forearm flap including vascularised nerve, bone or tendons. This paper describes and discusses some of these applications and is based on a series of 17 patients who presented with problems of reconstruction in the hand.

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Cited by (196)

Versatility of the perforator radial artery flap in the reconstruction of the upper limbs and comparison of the outcomes with the “classic” radial flap, a retrospective study
2023, Journal of Orthopaedics
Radial forearm flap, first described in the early eighties in China, is a well-known and handy flap to cover soft tissue defects of the distal upper limb. It has, though, some inconveniences, such as the sacrifice of the radial artery and non-neglectable esthetic sequelae in the donor site. In the following years, a similar flap based on the perforators of the radial artery has been described as achieving similar results, allowing to spare a main vessel. The authors reviewed retrospectively the patients that underwent surgery with one of those two flaps in their center to compare outcomes.
Patients operated between January 2016 and January 2022 have been reviewed. Ten had a classic radial artery flap, and ten had a radial artery perforator flap. Twelve weeks after surgery, Vancouver Scar Scale was used to assess the results at the donor site and over the flap. Reintervention and failure rate within one year and patient satisfaction -using a visual analog scale ranging from 0 to ten-at 12 months were also assessed.
All classic radial artery flap group patients had “successful” surgery, and none needed secondary surgery. On the other side, three patients required a second surgery in the perforator flap group, and nine out of ten ended up with “successful” flaps. Mean Vancouver Scar Scale results regarding the flap are comparable, whereas those at the donor site are significantly better in the patients with the perforator flap. Patients’ satisfaction results are similar in both groups.
The radial artery perforator flap is an important flap to be held in mind by all surgeons approaching reconstruction of the elbow, the forearm, and the hand, and should be preferred, when possible, to the classic radial forearm flap.
Use of free radial forearm and pronator quadratus muscle flap: Anatomical study and clinical application
2022, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Further refinements and delineation of its vascular anatomy increased the reliability and applicability of this flap. The RFF has been described as a fasciocutaneous multicomponent tissue flap, including a vascularised radial bone segment, nerves (the lateral and medial antebrachial cutaneous nerves), tendons and muscles (brachioradialis, flexor carpi radialis and palmaris longus).4-7 None of the previous studies have mentioned the clinical application of a multicomponent flap combining free RFF flap with pronator quadratus muscle (PQM).
The authors present an anatomical study and clinical experience with radial forearm flap (RFF) and pronator quadratus muscle (PQM) application in the reconstruction of various body areas. The aim was to describe the anatomical placement and proportions of the PQM, the anatomical location of the major arterial branch of the radial artery supplying the PQM, and the application of this knowledge in clinical practice.
The anatomical study was based upon an analysis of 13 fresh adult cadaver upper extremities, of which nine were female and four male; both arms from the same donors were used in four cases. The study of the PQM was performed using a dye-containing intraarterial injection, standard macro– and micro–preparation techniques, and chemical digestion. The data on the PQM size in males and females, thickness of the radial artery branch (the principal artery nourishing the muscle), and its position were analysed. The radial artery branch nourishing the PQM was identified in all cadaveric specimens of the anatomical study.
In addition, 12 patients underwent reconstructions of soft and bony tissue defects using a RFF + PQM (pedicled or free flap). The radial artery branch perfusing the PQM was identified in all cases. The flap was used for the management of defects of the head (seven cases), arm (three cases) and lower leg (two cases). The harvest site healed well in all cases and, with the exception of one case in which a partial necrosis of the flap was observed, all flaps remained viable, which demonstrated the safety of the method.
Aesthetic functional reconstruction of the mutilated hand: Indications and selection of reconstructive techniques
2020, Annales de Chirurgie Plastique Esthetique
Advances in microsurgery together with improvements in reconstructive surgical techniques over recent decades have enlarged the scope of available techniques for mutilated hand reconstruction, shifting the reconstructive paradigm from restoring hand function to providing the best functional and aesthetic results with minimal donor-site morbidity. Successful reconstruction of a mutilated hand should no longer be measured only by the degree of improvement of hand function but also by a more aesthetic hand appearance as well as by improved psychological well-being. In this article, the authors present their concept of aesthetic functional reconstruction of the mutilated hand with a focus on the indications and selection of reconstructive techniques. They emphasize that in order to select the most appropriate technique, providing the best functional and aesthetic outcomes with minimal donor-site morbidity for each individual patient, it is imperative for the reconstructive hand surgeon to possess perfect mastery of all available surgical techniques, thorough understanding of functional and aesthetic requirements and accurate appreciation of multidimensional reconstruction of a given defect of the hand. They have concluded that in precisely indicated cases, successful replantation of an amputated hand or digits remains the best reconstructive procedure designed to obtain a more functional and more normal-appearing hand, whereas, toe-to-hand transplantation, in cases of failed or impossible digit replantation, provides better results than any other digit reconstruction techniques aimed at achieving functioning digits with good appearance. Although skin graft and various distant pedicled flaps and free flaps may be valid options for coverage of some soft tissue defects of the hand, reverse flow forearm flaps, especially those based on the secondary arteries of the forearm, are often the best-suited reconstructive options for like-with-like hand reconstruction. They can provide the best matching of color, texture, soft-tissue volume, donor-recipient tissue interface and fulfill all the aesthetic and functional reconstruction requirements of moderate-sized or even large soft tissue defects of the hand, with acceptable donor site morbidity.
Secondary digit reconstruction of mutilated hand
2019, Annales de Chirurgie Plastique Esthetique
L’amputation digitale traumatique engendre un handicap sur les plans fonctionnel, esthétique et psychique pour le patient. De telles séquelles post-traumatiques imposent une démarche thérapeutique rigoureuse en vue d’une chirurgie secondaire précoce, idéalement réalisée avant le « deuil » par le patient de son traumatisme initial. Le principe thérapeutique consiste à améliorer la fonction globale de la main avec pour objectif de base d’établir une pince pollici-digitale de qualité, idéalement fine, stable, sensible, forte, mobile et en même temps, si possible, d’améliorer l’aspect esthétique de la main. L’arsenal thérapeutique inclut non seulement les procédés chirurgicaux faisant appel à des ressources locales visant à une meilleure utilisation du capital digital restant, notamment la phalangisation, les techniques d’allongement, d’amputation proximale, de translocation et de redistribution digitale, mais également les procédés qui ont recours à un prélèvement à distance, tels que les techniques ostéoplastiques et les transferts d’orteils. Les auteurs présentent leur approche et leurs indications quant aux différents procédés de chirurgie secondaire après amputation digitale traumatique. Ils concluent qu’une connaissance et une maîtrise parfaite du vaste arsenal thérapeutique disponible, une analyse fine et approfondie des avantages et des inconvénients de chaque technique chirurgicale envisageable, une prise en considération d’éléments tels que l’âge, le sexe, la profession, la main dominante, l’état local de la main mutilée, l’état physique, psychique et le désir du patient sont autant d’éléments indispensables à prendre en compte en vue de définir la meilleure solution thérapeutique possible.
Traumatic digit amputation generates functional, aesthetic and psychological disabilities. Such post-traumatic consequences call for a rigorous therapeutic approach, aiming at an early secondary surgical procedure – which is ideally to be performed before the patients psychologically recover from their initial trauma. The therapeutic principle consists in improving the global function of the hand, basically aiming at re-creating a quality pollici-digital pinch, ideally thin, stable, sensitive, strong, mobile enough, but also, when possible, at improving the aesthetic aspect of the hand. The therapeutic arsenal includes not only surgical processes using local ressources in order to improve the allocation of the remaining digital capital such as phalangisation, elongating techniques, proximal amputation, digital translocation and redistribution but also remote processes – such as osteoplastic and toe-to-hand transfer techniques. The authors expose their approach and indications of secondary digit reconstruction procedures in mutilated hand. They conclude that a thorough knowledge and mastery of the vast available therapeutic arsenal, a fine and profound analysis of the benefits and downsides of each available surgical technique, a comprehensive acknowledgement of the patient's personal information such as age, gender, profession, dominant hand, status of the mutilated hand, physical and psychological health as well as patient's desire are all necessary in order to define the best therapeutic strategy for each particular case.
Quality of Life After Oral Cancer Resection and Free Flap Reconstruction
2019, Journal of Oral and Maxillofacial Surgery
This study focused on quality of life for patients in northeast China who underwent oral cancer resection directly before flap reconstruction. In addition, this study compared differences among the radial forearm free flap (RFFF), ulnar forearm free flap (UFFF), and anterolateral thigh flap (ALTF) for defect reconstruction.
To assess patients' quality of life, the University of Washington Quality of Life and 14-item Oral Health Impact Profile (OHIP-14) questionnaires were completed 6 months after reconstruction.
The flap size of the ALTF group was much larger than that of the UFFF and RFFF groups. The appearance score of the ALTF group was markedly higher than that of the UFFF and RFFF groups, whereas these groups had a much higher swallowing score than the ALTF group. Furthermore, the ALTF group had much lower social disability OHIP-14 scores than the RFFF group.
The results indicate that all 3 reconstruction methods are similar, but that the ALTF has a slight advantage over the UFFF and RFFF.
Free flaps for lower limb soft tissue reconstruction in children: Systematic review
2019, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Other reconstructive methods can be considered as a second choice on the basis of their low incidence, and their indication for use depends on the case and the experience of the surgeon. With its low rate of complications and secondary procedures (16% for both), the RFA fasciocutaneous flap seems an excellent option for lower limb reconstruction because it can be combined with bone,71–73 tendons,73 or cutaneous nerves.72–74 The huge disadvantages remain the cosmetically unacceptable appearance of the donor site and the sacrifice of the main artery to the hand, which could lead to functional impairment.
Since the first reports on microsurgery in children, there has been an evolution in the reconstruction of soft tissue defects as evidenced by a shift to free flaps as the first-line treatment.
The primary objective of this systematic review was to compare the complication rate of free perforator/fasciocutaneous flaps with free muscular/myocutaneous flaps in pediatric lower limb soft tissue reconstructions. The secondary objective was to evaluate the frequency and severity of complications for both reconstructive options.
A search was performed in the databases PubMed, Web of Science, Embase, Scopus, and Cochrane Library depending on predefined inclusion criteria.
The evolution to perforator flaps from muscular and myocutaneous flaps is reflected in this systematic review as demonstrated by the anterolateral thigh (ALT) flap, which is the most common reconstructive option with a very low complication rate (11.3%) and flap loss. The latissimus dorsi (LD) flap was the second most frequently reported reconstruction with a complication rate comparable with that of the thoracodorsal artery perforator (TDAP) flap (32% vs. 39%, respectively), but the former suffers few failures. The radial forearm (RFA) fasciocutaneous flap can be considered a good alternative for ALT and TDAP flaps with a very low complication rate (16%) and no flap loss.
The ALT flap is considered the best reconstructive method for pediatric lower limb soft tissue defects. More adequate prospective studies specifically concerning free flap reconstructions for lower limb defects in children are necessary in the future to provide guidelines for treatment and optimize outcomes in the long term.

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A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap

Abstract

British Journal of Plastic Surgery

British Journal of Plastic Surgery

British Journal of Plastic Surgery

British Journal of Plastic Surgery

The Hand

Clinics in Plastic Surgery

Das Arterien System der Japaner. Kyotc

Maruzen

Reconstruction of the amputated fingertip with a triangular volar flap. A new surgical procedure

Journal of Bone and Joint Surgery

Les arte`res de la main

Thumb reconstruction with contiguous skin-bone pedicle graft

Plastic and Reconstructive Surgery

Tensor fascia lata myocutaneous free flaps

Plastic and Reconstructive Surgery

Le de´graissage primaire et total des lambeaux d'autoplastiea`distance

Annals de Chirurgie Pastique