Preoperative vascular assessment: an aid to radial forearm surgery

Twenty-three patients undergoing oral reconstructive surgery with radial forearm free flaps had a vascular assessment of the forearm preoperatively. Segmental upper limb pressures were measured and colour flow duplex visualization of forearm vessels and blood flow done. In 18 the blood pressure and flow were within normal limits, but five (22%) showed either unilateral or bilateral arteriopathy or aberrant vascular anatomy. Identification of pre-existing vascular disease helps to rationalize the selection of donor vessels, reduces the risk of ischaemic damage to the hand after disruption of the radial artery and may be of benefit in reducing the incidence of failure of free flaps.