The radial forearm flap: a biomechanical study of the osteotomized radius

An experimental study was undertaken to determine the effect of an osteotomy on radial strength and to compare two techniques used clinically to perform these osteotomies. Forty preserved human cadaveric radii were randomized into osteotomized (20) and nonosteotomized (20) groups. Osteotomized bones were further randomized into beveled-corner (10) and squared-corner (10) groups. A 9-cm-long, one-third thickness segment of bone was removed, similar to the defect resulting from a radial osteocutaneous transfer. All bones were tested to breaking using a four-point bending apparatus. Osteotomized radii were significantly weakened, with breaking strengths only 24 percent of the control group. Although the beveled osteotomy group appeared stronger than the squared osteotomy group, this finding was not significant with the numbers tested. In view of the weakness of the osteotomized radius, we recommend excising no more than one-third of the radial diameter and postoperative immobilization of the forearm for 8 weeks. A beveled osteotomy prevents overcutting at the corners and allows better visualization of the depth of cut. With these measures, the incidence of fracture may be reduced.