The reverse-flow radial forearm flap provides excellent coverage for distal
upperlimb defects. It is simply raised and does not require microsurgical
skills. However, since its vascular pedicle is reversed, its venous outflow
can be significantly diminished because of the venous valves. The authors
present the case of a 16-year-old patient with a sagittal amputation of the
radial aspect of the right thumb, who manifested at the time of surgery ma
rked venous engorgement of a reverse-flow radial forearm flap. This was suc
cessfully relieved by the placement of a mechanical leech consisting of a S
ilastic rubber catheter-of the kind used to gain central vascular access in
newborns-introduced in the lumen of the reversed vein at the extremity of
the flap. This permitted intermittent evacuation of blood from the flap pos
toperatively, contributing to the success of this procedure. The technique
used is detailed and pertinent literature is reviewed.