Raynaud's phenomenon in radial forearm free-tissue transfer

During 1998, 69 patients underwent either fasciocutaneous or osteofasciocutaneous radial forearm free-tissue transfers at our institution. Three of these patients (4.3%), who had undergone a total of four transfers, had Raynaud's phenomenon. Three of the four transfers survived without perioperative incident. The one flap that failed had been well vascularized until postoperative day 3. Then, coincident with a decrease in ambient room temperature, the patient's extremities and his flap became cyanotic. A salvage procedure was unsuccessful. In this article, we discuss the perioperative course, proposed pathophysiology, and treatment strategies aimed at optimizing hand and flap outcomes in patients with Raynaud's phenomenon.