Immediate de-syndactylization of the reverse radial forearm flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Hand Surgery

Background:

• Soft tissue defects on the hand and fingers present significant reconstructive challenges.
• The reverse radial forearm flap is a versatile option for covering such defects.

Purpose of the Study:

• To evaluate the efficacy of the reverse radial forearm flap for soft tissue defects on the dorsal hand and fingers.
• To assess the outcomes of immediate de-syndactylization of the flap's distal portion.

Main Methods:

• The reverse radial forearm flap was employed in four patients to cover defects on the dorsal hand and fingers.
• A total of 14 fingers were reconstructed using de-syndactylized flap segments.
• Flap segments were categorized into two groups based on defect proximity to the proximal interphalangeal (PIP) joint.

Main Results:

• Primary wound healing occurred at the proximal and lateral flap edges in all cases.
• Delayed wound healing and distal edge necrosis were observed in five of the 14 flap segments (all from Group A, with defects extending to or distal to the PIP joint).
• No major skin loss occurred despite immediate de-syndactylization, indicating flap viability.

Conclusions:

• The reverse radial forearm flap provides a reliable blood supply for soft tissue reconstruction of the hand and fingers.
• Longer flap segments (extending to or distal to the PIP joint) are associated with a higher risk of distal edge ischemia.
• Immediate de-syndactylization is a safe procedure with this flap, supporting portions with random blood supply without significant necrosis.