Preoperative evaluation of the radial forearm free flap patient with the objective Allen's test

OBJECTIVE: The conventional subjective Alien's test (SAT) can be problemati c because of its subjective nature. The objective Alien's test (OAT) was us ed before surgery to reliably and objectively assess forearm vascular flow in anticipation of harvesting a radial forearm free flap (RFFF) for use in head and neck reconstruction. STUDY DESIGN AND SETTING: Retrospective analysis of 65 patients undergoing both preoperative SAT and OAT was completed at the University of Kansas Med ical Center between December 1994 and March 1998. RESULTS: The sensitivity and specificity of the SAT compared with the sensi tivity and specificity of the OAT were only 65% and 76%, respectively. In 4 0 patients with at least 1 forearm with a positive SAT, only 1 (2.5%) patie nt was found by OAT to have vasculature that would not have allowed safe RF FF harvest in either forearm. In contrast, of the 25 patients with equivoca l or negative SAT results in both arms, 18 (72%) were found by OAT to be sa fe candidates for RFFF harvests. CONCLUSIONS: The OAT is an objective measure of forearm vascular flow and i s superior to conventional SAT in RFFF donor-site selection.