Island adipofascial flap based on distal perforators of the radial artery: an anatomic and clinical investigation.

Abstract

Reconstruction of soft-tissue defects of the hand with exposed tendons, joints, and bone represents a challenge to the plastic surgeon, and such defects necessitate flap coverage to preserve hand function and to protect its vital structures. Reported here is the study of an island adipofascial flap based solely on the distal five to eight septocutaneous perforators of the radial artery and their venae comitantes. Designing the flap in the form of an island with skeletonization of the distal perforators of the radial artery ensures its vascular pattern from these perforators alone with no connection to the ulnar artery perforators or posterior interosseous artery perforators, as is the case with fascial pedicled flaps. Furthermore, designing the flap as an island facilitates the arc of rotation and avoids the pedicle kink when the flap is turned 180 degrees. Preservation of the radial artery, as well as the mild thickness of the flap are further advantages. The drawbacks of such a flap include temporary impaired sensation at the donor site, the obvious scar in the forearm, and loss of hair. Eleven fresh and fixed cadaver upper extremities were dissected to delineate the vascular pattern and to define the arc of rotation of the flap. Also, a clinical approach was conducted on two patients who sustained extension scar contracture with tendon adhesions of the dorsum of the hands, on two patients who sustained first web space contracture, and on two patients who had full-thickness soft-tissue loss over the palm; and finally on two patients who sustained traumatic soft-tissue loss over the dorsum of their hands with exposed tendons and metacarpal bones.