TY - JOUR
T1 - Radial forearm free flap morbidity
T2 - A rare case of a normal preoperative arteriogram and acute intraoperative hand ischemia
AU - Bruner, Terrence W.
AU - Hanasono, Matthew M.
AU - Skoracki, Roman J.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2011
Y1 - 2011
N2 - Since its first description in 1981, the radial forearm free flap has become a valuable tool for reconstructive microsurgery. However, there are potential complications associated with the flap - the most feared being hand ischemia from sacrifice of the radial artery. Fortunately, acute ischemic complications are exceedingly rare, with only two cases reported in the literature. Options for preoperative evaluation of the donor extremity include the Allen's test, ultrasonography and angiography. A preoperative arteriogram is considered to be the definitive method to evaluate arterial anatomy, patency, and collateralization between the radial and ulnar arteries. The current article presents the authors' experience with a patient who had a delayed Allen's test and a normal arteriogram of his left upper extremity, and who developed acute intraoperative hand ischemia, requiring reconstruction of his radial artery, after elevation of a radial forearm free flap. Although exceedingly rare, the occurrence of acute vascular insufficiency is always a possibility and must be kept in mind when harvesting a radial forearm free flap. The surgeon should be prepared to perform an interposition vein graft reconstruction to avoid any potential complications. Clinical examination and judgment may be more important than radiological studies in certain cases.
AB - Since its first description in 1981, the radial forearm free flap has become a valuable tool for reconstructive microsurgery. However, there are potential complications associated with the flap - the most feared being hand ischemia from sacrifice of the radial artery. Fortunately, acute ischemic complications are exceedingly rare, with only two cases reported in the literature. Options for preoperative evaluation of the donor extremity include the Allen's test, ultrasonography and angiography. A preoperative arteriogram is considered to be the definitive method to evaluate arterial anatomy, patency, and collateralization between the radial and ulnar arteries. The current article presents the authors' experience with a patient who had a delayed Allen's test and a normal arteriogram of his left upper extremity, and who developed acute intraoperative hand ischemia, requiring reconstruction of his radial artery, after elevation of a radial forearm free flap. Although exceedingly rare, the occurrence of acute vascular insufficiency is always a possibility and must be kept in mind when harvesting a radial forearm free flap. The surgeon should be prepared to perform an interposition vein graft reconstruction to avoid any potential complications. Clinical examination and judgment may be more important than radiological studies in certain cases.
KW - Angiogram
KW - Hand ischemia
KW - Radial forearm free flap
KW - Vein graft
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U2 - 10.1177/229255031101900314
DO - 10.1177/229255031101900314
M3 - Article
AN - SCOPUS:80054790331
SN - 1195-2199
VL - 19
SP - 102
EP - 104
JO - Canadian Journal of Plastic Surgery
JF - Canadian Journal of Plastic Surgery
IS - 3
ER -