Shape-Modified Radial Artery Perforator Flap Method: Analysis of 112 Cases

Abstract

To overcome the donor-site morbidity associated with radial forearm flaps, many modifications of this technique have been reported, including the development of the perforator flap method. In this article, the authors analyze the efficacy of their shape-modified radial artery perforator flap method. The authors analyzed all of their 112 cases of reconstruction with the shape-modified method with regard to the cause of injury, recipient site, whether the flap was free or pedicled, flap size, number of components that were divided by perforators, flap survival, and quality of the outcome. Donor-site morbidity, including the development of scars and dorsal hand numbness, was also evaluated. The reconstructed areas were the head and neck (27 cases, 24.1 percent), upper extremity (58 cases, 51.8 percent), and lower extremity (27 cases, 24.1 percent). Free flaps were used in 75 cases (67.0 percent). In total, 109 flaps (97.3 percent) survived completely, but three free flaps exhibited venous thrombosis. In terms of aesthetics, 48 cases had excellent outcomes (42.9 percent), 61 cases had good outcomes (54.5 percent), and three cases had poor outcomes (2.7 percent). Impaired blood circulation and numbness of the donor hand were never observed, but one patient complained about a donor-site cosmetic problem. The authors' flap can be considered as a kind of propeller flap. It also resembles the flap-in-flap method. It is suitable for a wide range of surgical indications and is useful and safe in not only adults but also young and elderly patients.