Successful transfer of two reverse forearm flaps despite disruption of both palmar arches

The advantages of the ipsilateral forearm flap in emergency post-traumatic hand reconstruction are now well-established. A prerequisite for such a transfer has always been the presence of at least one intact palmar arch. We report the successful transfer of two reverse forearm flaps despite disruption of both palmar arches. In both cases the flap was raised on the vascular axis which had ceased to contribute significantly to the hand circulation. The anatomical basis of this transfer is discussed.