Abstract
BackgroundThe radial forearm free flap is a workhorse free flap. The radial artery, which supplies it, is increasingly being used for endovascular access. A complication of this is radial artery occlusion. Although often asymptomatic it can compromise future free tissue transfer.Case PresentationTwo patients who underwent RFFF harvest for head and neck reconstruction are presented; both of who likely had distal radial artery occlusion.The first patient had failure of flap perfusion, presumed secondary to radial artery occlusion from prior endovascular access at the distal radial artery. In the second case, we used the Allen’s test in reverse to identify the same scenario and successfully redesigned the harvest.ConclusionThe Allen’s test is a simple bedside test that should be performed bidirectionally to exclude radial artery occlusion, which may compromise flap harvest. Radial artery occlusion will become increasingly common as the radial artery is used more frequently for endovascular access procedures.
Highlights
The radial forearm free flap is a workhorse free flap
Radial artery occlusion will become increasingly common as the radial artery is used more frequently for endovascular access procedures
First described in 1929 by Edgar Allen, the Allen’s test has become the most common method for assessing palmar arch patency [1]. Allen originally described his test for diagnosis of thromboangiitis obliterans of the ulnar artery more recently it has been used to assess the adequacy of the ulnar collateral blood flow through the palmar arches prior to radial artery sacrifice during cardiac surgery and reconstructive surgery [2]
Summary
The Allen’s test is a time-honored, simple and non-invasive test to assess arterial flow through the palmar arches of the hand. It is important to remember that this is a bidirectional test and it should be performed in both directions prior to RFFF harvest This can prevent both ischemic hand complications and ensure that radial artery inflow to the distal forearm is sufficient to ensure a RFFF will perfuse after harvest. We highlight these technical details through two illustrative cases because we believe it is increasingly relevant in the current era where the radial artery is frequently being used as an access site for invasive monitoring and therapeutic endovascular procedures. All authors were involved in revising the manuscript critically for important intellectual content. All authors agree to be accountable for all aspects of the work
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
