[Revascularization and defect coverage of the hand: special applications of the radialis forearm flap]

During the last years, a large number of newly designed flaps have been presented, suitable to cover defects of the hand. Some of them, namely the retrograde interossea-posterior and the lateral arm flaps, found their way into daily clinical routine. They even seem to have replaced the standard flaps for defect coverage to the hand, the pedicled groin flap and the radial forearm flap. Especially the radial forearm flap seems to become an obsolete procedure, as it requires sacrificing a main forearm artery. Three patients are presented who suffered from complex injuries to their hands and were treated with radial forearm flaps in a single-stage primary procedure. In two hands, the arterial palmar arches and the soft-tissues of the palm were reconstructed by use of a distally pedicled radial forearm flap. Collateral arteries of ischemic fingers were implanted into the flap artery to achieve revascularization and a vein graft was interposed between the stumps of the radial artery to reestablish an orthograde blood flow. A free radial forearm flap harvested from the contralateral uninjured forearm was used to replant a torn-out forearm. In all cases, primary healing was achieved without complications. Primary treatment of complex injuries to the hand and forearm often requires revascularization of ischemic parts of the limb and coverage of large soft-tissue defects at the same time. The radial forearm flap, either as a distally pedicled flap or as a free flap, meets all the needs or in particular is appropriate to perform such demanding primary procedures. The destruction of the arterial palmar arches does not present a contraindication against the use of a distally pedicled radial forearm flap, but actually is a strong indication to reconstruct the radial artery by a vein graft.