Angiologic observations following radial artery flap elevation: a case report

Since the introduction of the radial forearm flap in 1981, its inherent vascular morbidity in sacrificing the radial artery has been strongly criticized. In the present paper, a case report is presented where postoperative angiography showed an important contribution of the anterior interosseous artery to hand vascularity two years after raising a reverse flow distally based pedicle radial forearm flap for dorsal hand resurfacing. In order to analyze this finding, further vascular investigations using Color Duplex Imaging examinations for quantitative flow measurements comparing blood flow rates in both right and left forearm arteries were carried out in this patient. Contrary to expectations, results from vascular examinations revealed that overall blood flow in donor forearm arteries was greater than in the contralateral forearm, the anterior interosseous artery showing the greatest difference in blood flow. These data seem to indicate that another major vascular axis based on the anterior interosseous artery develops after removing the radial artery when harvesting the radial forearm flap and that global arterial inflow to the hand is not impaired.