Use of distal arteries for microvascular reconstruction in forearm and hand surgery

Three techniques that use distal arteries for microvascular reconstruction in forearm and hand surgery are described: (1) distal based supply from the deep branch of the radial artery, (2) proximal reversal of the radial artery, and (3) distal based supply from the ulnar artery. Nine cases are described to illustrate the use of these techniques: three vascularized bone grafts, three toe-to-hand transfers, one free cutaneous flap, one brachial artery reconstruction, and one replantation of an amputated palm. The technique offers a number of advantages: (1) it eliminates the need for vein grafts, (2) it requires only a single arterial microvascular anastomosis, (3) it minimizes microvascular size discrepancies, (4) the distal artery can be prepared in the same operative field as the rest of the reconstruction, and (5) the technique enables an undamaged artery to be brought into a zone of trauma and used as a recipient vessel. The technique has the disadvantage that it sacrifices part of the collateral circulation to the hand and it is therefore important to check the blood supply to the hand preoperatively.