Free forearm flap for reconstruction of soft tissue defects concurrent with improved peripheral circulation

The free forearm flap is an accepted procedure for covering defects due to osteitis in the lower leg. End-to-end anastomoses have usually been preferred, if the diameters of the donor and recipient arteries are more or less equal. However, if one or more arteries of the lower leg are absent, end-to-end anastomosis is not indicated, because further disturbances of blood circulation will ensue. We present a procedure in which the flap vessels act as an arterial and venous bypass, thus improving the circulation in the lower leg, while concurrently perfusing the flap. Following full thickness skin graft, cosmetic results at the donor site are not especially pleasing. Results can be improved by a split skin graft (used as a mesh graft), and by situating the donor site on the upper third of the forearm. At the recipient site, the flap can be infolded and connected in anatomic right or reverse directions, depending on the required length of the flap vascular pedicle needed for reconstruction. This can lead to a reverse blood flow in he vessels of the transferred free forearm flap. The radial artery can be restored by vein graft from the same forearm. In 25 free forearm flaps to the lower leg, arterial bypass was performed in 14 cases, venous bypass as well in four cases, with reverse blood flow in three cases.