Immediate de-syndactylization of the reverse radial forearm flap

The reverse radial forearm flap was used to cover soft tissue defects on the dorsal aspect of the hand and fingers with immediate de-syndactylization of the distal part of the flap in four cases. A total of 14 fingers were covered with de-syndactylized segments and these were divided into two groups. In group A (nine fingers) the defect extended to or just distal to the proximal interphalangeal (PIP) joint. The defect in group B (five fingers) was proximal to the PIP joint. Primary wound healing was observed in the proximal and lateral edges of the flap in all cases. However, delayed wound healing was observed in the distal edge of five of the 14 segments. All five segments that suffered from edge necrosis were from group A, indicating that longer segments are more likely to develop distal edge ischaemia. The fact that there was no major skin loss in any of the patients despite immediate de-syndactylization indicates that the reverse radial forearm flap has a reliable blood supply and can support a portion with a random blood supply without significant necrosis.