RADIAL FOREARM FLAP

Uses

Upper limb, head and neck, lower limb, penis, oesophagus, etc.

10x40cm

Type C Fasciocutaneous Flap

Lateral and Medial Cutaneous nerves of the forearm

Radial artery, venae commitantes (x2), cephalic vein

Artery diameter 2.5mm

Preop Allen’s test

Mark superficial venous system prior to exsanguination and tourniquet

Long flap pedicle requires a more distal flap

Thinner more pliable skin more distally

Start ulnar aspect, and work towards radial aspect of flap

Cut down to deep fascia and raise fascia off underlying structures

Keep paratenon over exposed tendons

Seige approach to isolate vascular pedicle

Closure with pre-expansion, skin graft or local flap.

Reverse flap

Fascial flap,
Skin is preserved with suprafascial dissection of skin

	osseofasciocutaneous, Boat shape of radius is taken (<40% of circumference to prevent pathological fracture). Cuff of FPL and pronator quadratus is taken with bone. Iliac crest graft may be used to strengthen defect. Above elbow cast for 6 weeks, then dynamic cast brace for further 4 weeks.
	preop tissue expansion May help with donor site closure
	tendinocutaneous / musculocutaneous flap with palmaris longus, FCR or brachioradialis,
	vascularised nerve

Yang G, Chen B, Gao Y Forearm free skin flap transplantation [Chinese]. Natl Med J China 61:139, 1981.