The Bsteocutaneous Pedicle Forearm Flap

Two patients treated by an osteocutaneous radial island flap with retrograde blood flow are described. Rotation of the flap and its distal vascular pedicle by nearly 180 degrees caused no impairment of the arterial flow, but it may interfere with the venous return through the radial veins, as observed in one of our cases. Therefore, it is safer to include in the skin flap an additional vein, suturing it to a superficial vein in the recipient zone, thus ensuring normal venous flow to the flap as well. The purpose of this paper is to present two patients treated by the use of an osteocutaneous radial artery forearm flap. Case Report I. A male patient, aged twenty-two years who works as a mechanic, injured his left hand in May 1983, when it was crushed by a metal panel weighing two tons. This received a prolonged period of treatment both by surgery and physiotherapy. On admission to our hospital he presented the following condition: an extensive dense scar on the dorsum of the left hand, associated with a defect of the second metacarpal. The index extensors had been cut, and the metacarpophalan-geal joint showed a hyperextension contracture (Figures 1 and 2). Following careful preliminary examination, Doppler testing and vascular assessment of all digits, with and without Allen’s test, he was operated on in December 1983. On the volar-radial aspect of the forearm, in its middle third, a skin flap measuring 8 cm. in length and 6 cm. in width was tailor.ed. Using an additional S-shaped skin incision, running from the flap to the wrist, the radial artery and accompanying veins were exposed. The vascular bundle was carefully dissected after ligature of the tiny side branches. The wound was deepened beneath the flap, and without disrupting the connections, an osteoperiosteal segment was carfully Fig. 1 Cuse One Condition before operation. The skin flap is marked