The arterialized antebrachial skin flap for hand reconstruction

The authors present 20 microvascular flaps based on arteriovenous perfusion, harvested from the distal anterior forearm, and configured in three different designs. Indications were small palmar, dorsal, and commissural defects, when other conventional procedures were not available; problematic cases of open reduction internal fixation with skin defect; and when aggressive rehabilitation was needed. The follow-up varied between 6 and 28 months. Some degree of vascular congestion was observed in 100 percent of the flaps, and those changes were classified in a progressive form. Coverage was judged as stable, thin, and pliable in 75 percent of the cases in the series; aggressive rehabilitation was started promptly in all cases where this was possible. On average, an additional 2.4 hr were required for the original procedure. This flap demands little technical expertise for any microsurgical surgeon, and does not sacrifice any important donor vessel. The flap should not be followed-up by conventional monitoring methods instead, simple palpation of the pulse, Doppler auscultation, or PPG are required.