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Tousidonis M, Escobar JIS, Caicoya SO, Vila CN, Cuéllar IN, Montiel AD, López AML, Cuéllar CN. Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice. J Clin Med 2021; 10:jcm10153328. [PMID: 34362111 PMCID: PMC8347905 DOI: 10.3390/jcm10153328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior to the use of RFFF, several authors have reported potentially preventable serious vascular complications. This study included 87 consecutive patients with cancer of the oral cavity and RFFF as the flap of choice who were treated between 2010 and 2020, and compares the results of the Clinical Allen Test (CAT), the Doppler Allen Test (DAT) and the Surgical Allen Test (SAT). The preoperative vascular study found vascular abnormalities severe enough for the surgical team to change the preoperative flap of choice in 39% of patients. The Kappa index showed a weak concordance between the CAT and DAT. The study reflected a total concordance in the preoperative results of the Doppler study and the intraoperative results of the SAT. Due to its excellent agreement with SAT, the DAT would be the preoperative test of choice in patients who are candidates for RFFF. This study of vascular mapping tests with Doppler is intended to inform therapeutic decisions and present methods to gain information that cannot be obtained by physical examination alone.
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Tödtmann N, Weber A, Hollstein S, Kunkel M. A simple method for preconditioning radial forearm flaps in the case of an insufficient ulnar vascular supply: a retrospective clinical analysis. Int J Oral Maxillofac Surg 2021; 51:33-37. [PMID: 33838963 DOI: 10.1016/j.ijom.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/17/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Due to its versatile applicability, many reconstructive surgeons use the radial forearm flap (RFF) as the first choice for soft tissue replacement. Donor site limitations of the flap arise with an insufficient blood supply along the ulnar artery. This study presents a simple and safe method for RFF preconditioning by recruitment of the deep palmar arch via the ulnar artery. Fourteen patients scheduled for RFF surgery between 2013 and 2018 showed an insufficient vascular supply according to the Allen test, which was confirmed by digital subtraction angiography (DSA). These 14 patients underwent temporary ligature of one or both radial arteries with elastic vessel loops under local anaesthesia and continuous pulse oximetry. A control DSA was performed about 24hours later in 10 of the 14 patients. Recruitment of the blood supply along the enlarged ulnar artery or reanimated collaterals was confirmed in all 10 patients. No local complications such as ischemia of the hand were seen. All flaps could be harvested regularly and were used for different reconstructive purposes. This simple technique may help to overcome vascular limitations of the RFF via the rapid, efficient, and reliable recruitment of the biological vascular reserve. Within the limits of a case series, this procedure appears practicable and safe.
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Affiliation(s)
- N Tödtmann
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany.
| | - A Weber
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - S Hollstein
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - M Kunkel
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
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Della Rosa N, Bertozzi N, Colzani G, Adani R. A rare case of finger ischemia following bypass procedure with autologous vein graft for thumb revascularization: a case report and brief review of the literature. Eur J Plast Surg 2019; 42:205-210. [DOI: 10.1007/s00238-018-1466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdullakutty A, Bajwa MS, Patel S, D'Souza J. Clinical audit and national survey on the assessment of collateral circulation before radial forearm free flap harvest. J Craniomaxillofac Surg 2016; 45:108-112. [PMID: 27919594 DOI: 10.1016/j.jcms.2016.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/16/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022] Open
Abstract
Controversy exists regarding the use of Duplex Ultrasound (DUS) in addition to the Modified Allen's Test (MAT) for the assessment of collateral circulation prior to elevation of the Radial Forearm Free Flap (RFFF). A survey amongst members of BAOMS Head & Neck Oncology Subspecialty Interest Group and a completed local audit was undertaken to assess the need for DUS. Data for the initial audit was collected retrospectively between 2010 and 2013. Both MAT and DUS was performed routinely during this period. The results of the survey and initial audit led to a change in practice and DUS was no longer requested. The re-audit was performed prospectively between 2013 and 2015. The results of the survey showed that all respondents performed MAT. DUS was performed 'always' by 40%, 'sometimes' by 13.3% and 'never' by 46.7%. A total of 41 patients were included in the initial audit, 6 had an abnormal DUS but only 1 had an abnormal MAT. Five cases had an abnormal DUS but normal MAT and went on to have their ipsilateral RFFF raised without ischaemic complications. The patient with an abnormal MAT had their contralateral RFFF raised. No patients suffered ischaemic complications during the initial audit. A total of 48 patients were included in the re-audit 2 of which had an abnormal MAT and their contralateral RFFF raised. No patients suffered ischaemic complications during the re-audit. In conclusion, routine use of DUS did not provide any additional information above the MAT in identifying patients at risk of ischaemic complications.
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Affiliation(s)
- Anwer Abdullakutty
- Department of Maxillofacial Surgery, Royal Surrey County Hospital, Guildford GU27XX, UK.
| | - Mandeep S Bajwa
- Department of Maxillofacial Surgery, Royal Surrey County Hospital, Guildford GU27XX, UK
| | - Sonum Patel
- Department of Maxillofacial Surgery, Royal Surrey County Hospital, Guildford GU27XX, UK
| | - Jacob D'Souza
- Department of Maxillofacial Surgery, Royal Surrey County Hospital, Guildford GU27XX, UK
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Taylor SR, Jorgensen JB. Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer. Laryngoscope 2015; 125:E192-7. [DOI: 10.1002/lary.25190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Steven R. Taylor
- Department of Otolaryngology-Head and Neck Surgery; University of Missouri; Columbia Missouri U.S.A
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology-Head and Neck Surgery; University of Missouri; Columbia Missouri U.S.A
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Acar MA, Güleç A, Aydin BK, Erkoçak ÖF, Elmadag M, Türkmen F. Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps. Eur J Orthop Surg Traumatol 2014; 25:723-9. [PMID: 25274204 DOI: 10.1007/s00590-014-1544-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the midterm outcome and the degree of satisfaction of patients who underwent reconstruction of dorsal hand and finger defects with reverse flow radial fasciocutaneous forearm flaps and to test whether or not this is a reliable method which can be applied without the need for microsurgery. PATIENTS AND METHODS Eleven patients were admitted with post-traumatic complex hand defects and treated by reconstruction with reverse flow radial fasciocutaneous forearm flaps from January 2010 to May 2013. The patient demographics, size of the hand and finger defects, and complications were recorded. The functional status of each of the patients was evaluated using the quick disabilities of the arm, shoulder and hand (DASH) scoring system, and patient satisfaction was assessed using Likert scores. RESULTS The patients comprised nine males and two females with a mean age of 30.7 ± 9.7 years. The mean follow-up period was 18.4 ± 5.2 months. The average defect size was 41 ± 14.3 cm². None of the patients had circulation defects caused by the sacrifice of the radial artery. The mean quick DASH score was determined as 30.2 ± 15.3. The Likert patient satisfaction evaluation was good in one patient, and very good in ten patients. All flaps survived well with only two complications; superficial skin necrosis occurred at the suture site in one patient and venous insufficiency occurred in the other patient. Both complications recovered with secondary healing following wound debridement. CONCLUSIONS The reverse-flow radial forearm flap is a reliable method in the management of dorsal defects of the hand and does not require micro-surgical techniques.
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Affiliation(s)
- Mehmet Ali Acar
- Department of Orthopedics and Traumatology, Medical School of Selcuk University, Konya, Turkey,
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Tan ST, James DW, Moaveni Z. Reply to letter to the editor. Head Neck 2014; 36:1231-2. [PMID: 24599655 DOI: 10.1002/hed.23668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/03/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Swee T Tan
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Gillies McIndoe Research Institute, Wellington, New Zealand
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Chan RCL, Wei FC, Tsao CK, Kao HK, Chang YM, Tsai CY, Chen WH. Free flap reconstruction after surgical release of oral submucous fibrosis: Long-term maintenance and its clinical implications. J Plast Reconstr Aesthet Surg 2014; 67:344-9. [DOI: 10.1016/j.bjps.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/01/2013] [Indexed: 11/29/2022]
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Tan ST, James DW, Moaveni Z. Donor site morbidity of free ulnar forearm flap. Head Neck 2011; 34:1434-9. [DOI: 10.1002/hed.21943] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 07/16/2011] [Accepted: 08/03/2011] [Indexed: 11/08/2022] Open
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W Bruner T, M Hanasono M, J Skoracki R. Radial Forearm Free Flap Morbidity: A Rare Case of a Normal Preoperative Arteriogram and Acute Intraoperative Hand Ischemia. Canadian Journal of Plastic Surgery 2011. [DOI: 10.1177/229255031101900314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Terrence W Bruner
- University Medical Group, Greenville Hospital System, Greenville, South Carolina
| | - Matthew M Hanasono
- Division of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roman J Skoracki
- Division of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
Our understanding of the hemodynamic consequences of radial artery harvest to the upper extremity has changed our considerations when approaching soft tissue defects of the hand. A critical assessment of the donor site morbidity of radial forearm (and radial artery) harvest is necessary to discern the role this flap should have in our current and future reconstructive armamentarium. A review of the available data and discussion of its implications is provided.
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Affiliation(s)
- James P Higgins
- The Curtis National Hand Center, Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218, USA.
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Liu DX, Zheng CY, Li XD, Wang H, Du SX. Clinical Application of the Flap Based on the Distal Cutaneous Branch of the Ulnar Artery. ACTA ACUST UNITED AC 2011; 70:E93-7. [DOI: 10.1097/ta.0b013e3181f02979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
INTRODUCTION Reverse radial forearm flap has been proven reliable and effective for hand reconstruction. Here we report our experience with the use of reverse forearm flap that does not contain the radial or ulnar artery for reconstruction of hand defects in 65 cases with soft tissue defects of the hand. METHOD Sixty-five patients who sought surgical treatment for soft tissue defects of the hand at our hospital between January 2003 and December 2008 were included in the study. 39 cases had soft tissue defect on the dorsal aspect of the hand and 26 cases on the palmar aspect of the hand. 65 flaps were performed with the posterior interosseous artery flap in 26 cases, island flap supplied by the distal cutaneous branch of the ulnar artery in 23 cases, and the flap based on distally perforator of the radial artery in sixteen cases with the size of the flaps ranging from 5 to 12 cm in length and from 4 to 8 cm in width. RESULTS The distal cutaneous branch of the ulnar artery flap showed partial necrosis (25-35% of their area) in two cases. Both the donor and the recipient sites healed successfully in other cases. At 8.4 months of follow up, all patients had insensitivity in recipient sites. No patient complained of cold intolerance, pain, numbness and so on in the forearm and hand. According to the TAM criteria (the total active motion of the finger joint) and DASH (Disability of the Arm, Shoulder, and Hand) score showed that postoperative functions were excellent and symptoms were minor, with no significant differences among the groups (P > 0.05). CONCLUSION Our results indicated that the reverse forearm flap preserving the radial and ulnar artery is a reliable and effective method to cover skin defects of the hand.
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Affiliation(s)
- Dong-xin Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Medical College of Shantou University, 57 Chang Ping Road, Shantou 515041, Guangdong, China
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Huang JJ, Wallace C, Lin JY, Tsao CK, Kao HK, Huang WC, Cheng M, Wei FC. Two small flaps from one anterolateral thigh donor site for bilateral buccal mucosa reconstruction after release of submucous fibrosis and/or contracture. J Plast Reconstr Aesthet Surg 2010; 63:440-5. [DOI: 10.1016/j.bjps.2008.12.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 11/27/2008] [Accepted: 12/13/2008] [Indexed: 11/25/2022]
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Tsao CK, Wei FC, Chang YM, Cheng MH, Chwei-Chin Chuang D, Kao HK, Dayan JH. Reconstruction of the buccal mucosa following release for submucous fibrosis using two radial forearm flaps from a single donor site. J Plast Reconstr Aesthet Surg 2009; 63:1117-23. [PMID: 19581136 DOI: 10.1016/j.bjps.2009.05.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 05/18/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Oral submucous fibrosis is a collagen disorder affecting the submucosal layer and can severely limit mouth opening. The use of bilateral forearm flaps to fill buccal defects following trismus release has proven to be effective and reliable. However, it requires the sacrifice of radial arteries from both forearms. We have developed a technique that allows for the harvest of two independent flaps from a single forearm donor site. METHODS Two separate flaps are designed on the same radial artery and concomitant vein pedicle. The distal flap is marked in the standard fashion and the proximal skin paddle is designed in the middle third of the forearm, based on septocutaneous branches of the radial artery. The two flaps are elevated and subsequently divided into two independent free flaps. Between June 2004 and June 2007, a total of 16 flaps were harvested from eight donor sites for buccal mucosa defects following trismus release. Improvements in mouth opening and buccal pliancy were evaluated by comparing preoperative and postoperative inter-incisal distance (IID) and maximal mouth capacity. RESULTS All flaps survived completely, and all donor sites were closed primarily, except for one. The mean flap size was 6.6x2.6cm (range: 6x2.5cm-7x3cm), mean pedicle length was 5.7cm, mean ischaemia time was 46min and mean total operating time was 8h 45min. At an average of 19.8 months follow-up, the inter-incisal distance averaged 29.13mm, an increase of 20.88mm compared with the preoperative measurement. The maximal mouth capacity averaged 55.63cc, an increase of 9.38cc compared with the preoperative measurement. CONCLUSION Two independent small flaps can be harvested safely from one radial forearm donor site. This approach is a useful option for reconstruction of bilateral buccal defects, particularly following submucous fibrosis release. The donor-site morbidity is minimal and limited to one forearm.
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Affiliation(s)
- Chung-Kan Tsao
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kuei-Shan, Taoyuan 33305, Taiwan, ROC.
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Knobloch K, Tomaszek S, Spies M, Lichtenberg A, Busch KH, Vogt PM. No change of palmar microcirculation at rest 2 years after radial artery harvesting. J Plast Reconstr Aesthet Surg 2009; 62:920-6. [DOI: 10.1016/j.bjps.2007.11.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 08/20/2007] [Accepted: 11/04/2007] [Indexed: 11/17/2022]
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Abstract
We aimed to assess the blood flow through the radial and ulnar arteries at the wrist in chronic smokers, after a clinical observation that the ulnar artery is often difficult to palpate in chronic smokers. Sixty-four smokers and 36 non-smokers were recruited. The blood vessels were examined by palpation, and we used the hand-held Doppler and the Allen test to illustrate the dependence of the blood supply on one or the other vessel. The study showed that in 57 of the 64 chronic smokers (89%) the ulnar artery was difficult to palpate and in 28 (44%) dominant and 35 (55%) non-dominant hands blood flow through the ulnar artery was assessed as being poor using the hand-held Doppler. The Allen test was, however, within the normal limit of two seconds in all patients in this study.
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Affiliation(s)
- Syed N Ali
- Department of Plastic and Reconstructive Surgery, George Eliot Hospital, Nuneaton, Warwickshire, United Kingdom.
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Varley I, Carter LM, Wales CJ, Warnock N, Whitfield PH. Ischaemia of the hand after harvest of a radial forearm flap. Br J Oral Maxillofac Surg 2007; 46:403-5. [PMID: 17996999 DOI: 10.1016/j.bjoms.2007.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2007] [Indexed: 11/16/2022]
Abstract
The development of ischaemia in the hand after harvest of a radial forearm flap is extremely rare. Previous cases have been caused by anatomical anomalies or conditions that may have been detectable by ultrasonography. We report the development of ischaemia after harvest of a radial forearm flap despite a normal preoperative Allen's test and a normal Doppler ultrasound scan, in a non-smoker with no evidence of peripheral vascular disease. Angiographic appearances suggested that the ischaemia may have been secondary to an incomplete superficial palmar arch. This case highlights the potential for development of ischaemia despite normal preoperative investigations, with obvious ramifications for obtaining consent.
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Affiliation(s)
- Iain Varley
- Department of Oral & Maxillofacial Surgery, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
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Knobloch K, Tomaszek S, Busch KH, Vogt PM. Palmar microcirculation does not deteriorate 2 years after radial artery harvesting—implications for reconstructive free forearm flap transfer. Langenbecks Arch Surg 2007; 392:315-22. [PMID: 17384959 DOI: 10.1007/s00423-007-0178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The functional consequences after radial artery-based forearm flaps for hand microcirculation remain unclear. We hypothesized that palmar microcirculation is compromised after radial artery removal in arteriosclerotic patients. MATERIALS AND METHODS A total number of 114 patients were included undergoing elective coronary revascularization using the radial artery of the nondominant forearm with non-pathological Allen's test. Palmar microcirculatory mapping with 1596 measurements was applied 2 years after removal of the radial artery regarding capillary flow, finger tip oxygenation, as well as postcapillary venous filling pressures throughout both hands using combined noninvasive real-time laser Doppler flowmetry and spectrophotometry. RESULTS Only 2/56 positions revealed a difference beyond a 5% threshold 25 +/- 5 months after radial artery removal. Superficial capillary blood flow decreased by 13% at the hypothenar eminence (242.0 +/- 153.6 vs 275.6 +/- 169.2, p = 0.009). Deep postcapillary venous filling pressure (8 mm) was significantly increased by 9% only at the fingertip of the fifth finger (112.4 +/- 49.7 vs 103.0 +/- 25.0, p = 0.033). No clinical signs of malperfusion were found after radial artery removal, and no patient was impaired in his daily palmar motor activity. CONCLUSIONS Pedicled removal of the radial artery does not compromise superficial or deep palmar capillary blood flow, finger tip oxygenation, or postcapillary venous filling pressures in a long-term perspective in arteriosclerotic patients. No clinical relevant signs of malperfusion or any deterioration of palmar motor function was encountered. The blood flow via the ulnar artery and the interosseal artery compensates palmar perfusion without microcirculatory deterioration even more than 2 years after removal of the radial artery.
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Affiliation(s)
- K Knobloch
- Plastic, Hand and Reconstructive Surgery, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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