Exploiting the perforator concept to minimise donor site morbidity in harvesting the radial forearm free flap

Abstract

Fig. 1. Propeller flap marked by reverse planning technique (note blue dot denoting position of perforator vessel). he radial forearm free flap (RFF) is a highly versatile and eliable workhorse flap but its harvest often leaves a signifiant donor site requiring soft tissue coverage. Most often this s achieved through the use of a skin graft, which aside from eing unaesthetic has been reported to fail (full or partial) ue to the poor “take” observed over the exposed flexor carpi adialis tendon. Even if the skin graft does not fail it may till cause adhesions with the underlying musculo-tendinous tructures.1,2 We describe the use of a propeller flap based on n ulnar artery perforating vessel to avoid these problems. The location and anatomy of the ulnar artery and its perorators have been well described in the literature and can be asily located using a hand-held Doppler device. These ulnar erforators have been shown to be reliable in supporting a arge skin paddle and can be used to form flaps based on the roximal, middle, and distal forearm regions.3 Flaps raised n this territory also leave donor sites that are amenable to irect closure and are aesthetically pleasing.4 Following harvest of the RFF the ulnar border of the donor ite incision in the proximal third/middle third of the forerm is elevated at the subfascial plane. Dissection precedes lnarwards until a suitable perforator is identified. Reverse lanning marks out an elliptical flap (Fig. 1) and the flap is slanded on the perforator (Fig. 2). In the case shown, the ◦ ap was rotated approximately 150 and inset into the donor ite defect (Fig. 3). The mobility of the surrounding skin of