Osteocutaneous radial forearm flap for hand reconstruction

We treated 5 patients (4 men and I woman)with bone and soft tissue defects or total thumb loss using an osteocutaneous radial forearm flap. Their ages at the time of surgery ranged from 27 to 65 years (mean, 53 years). Preope rative conditions were traumatic loss of the thumb in 3 cases and severe in juries with soft tissue and bone defects in 2. The length of the donated ra dius ranged from 2 to 7 cm(mean, 4.7 cm). In 4 patients the radial forearm flap was transposed, including the lateral antebrachial cutaneous nerve as a sensory flap. Simultaneous iliac bone grafting to the donor site was also performed in 4 of the cases. The follow-up period ranged from 44 to 87 mon ths (mean, 64 months). All flaps survived over their full extent. Radiograp hic bone union was attained after 2 to 3 months (mean, 2.5 months). Two-poi nt discrimination over the 4 sensory flaps ranged from 8 to 15 mm (mean, 10 .8 mm). No radius fractures occurred. No patients showed signs of vascular insufficiency from sacrifice of the radial artery. The radial forearm flap provides thin skin of good texture together with bone for a 1-stage reconst ruction. For patients with skin and bone defects of the hand, a radial fore arm osteocutaneous flap is recommended. This flap is also recommended for p atients with traumatic thumb loss, if the dorsalis pedis artery is absent, or if the patient declines using tissue from the foot. Copyright (C) 1999 b y the American Society for Surgery of the Hand.