Experiences with the flow-through radial forearm flap as a bridge in lower extremity reconstruction

Various techniques have been proposed in order to overcome recipient vessel problems in microsurgery. In cases with no suitable recipient vessels close to the defect, the flow-through flap is a valuable and reliable alternative for accessing healthy recipient vessels in a single stage. We describe our experiences with combined flaps and discuss the advantages of the flow-through radial forearm flap as a bridge. Between 2003 and 2009, eight combined flaps were used to reconstruct soft-tissue defects of lower extremities. Seven patients had acute or subacute wound with exposed bone and vascular injury caused by trauma, one had a chronic nonhealing wound. The flow-through radial forearm flap was used as a bridge flap with combined a cover flap in all cases. Radial forearm flaps provided recipient vessel lengthening. In one patient, the distal ALT flap failed and replaced with latissimus dorsi flap. Other postoperative courses were uneventful and all of flaps survived. In one patient although the flaps were healthy, sepsis developed and the extremity was amputated. Recovery and ambulation were achieved in the remaining patients. Combined flaps with the flow-through radial forearm flap are an appropriate technique for overcoming recipient vessel problems. Although the technique involves a more complicated procedure and increases the number of microvascular anastomoses, it is a valuable, safe and comfortable alternative in selected cases.