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. 2022 May;42(4):333-340.
doi: 10.1002/micr.30883. Epub 2022 Mar 17.

The arterialised saphenous venous flow-through flap for managing the radial forearm free flap donor site

Kimberley R Hughes  1   2 , Alisha Fong  1   2 , Warren M Rozen  2 , James C S Leong  1   2   3
Affiliations

The arterialised saphenous venous flow-through flap for managing the radial forearm free flap donor site

Kimberley R Hughes et al. Microsurgery. 2022 May.

Abstract

Background: The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site.

Method: A cohort study of six patients (five male, one female; mean age 59 [range 19-90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra-flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap.

Results: In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6-15 cm (mean 11.5 cm) and widths of 4-6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24-90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow-up of 6 months (4-24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15.

Conclusion: The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.

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Conflict of interest statement

There are no conflicts of interest for any of the authors or affiliations, and the authors declare no knowledge of any direct interest, particularly a financial interest, in the subject matter or materials discussed. The authors have no employment by an industrial concern, ownership of stock, membership on a standing advisory council or committee, a seat on the board of directors, or being publicly associated with a company or its products that may pose such an interest. The authors have no real or perceived conflict of interest that include receiving honoraria or consulting fees or receiving grants or funds from such corporations or individuals representing such corporations. There was no grant, research scholarship or financial support provided for the study. There is no conflict of interest on preparation of this manuscript.

Figures

FIGURE 1
FIGURE 1
Flap markings and design. (a) Pre‐operatively the course of the long saphenous vein is marked from above the medial malleolus to below the knee. The flap is designed centred over the long saphenous vein over the upper posteromedial leg. Smaller veins around the periphery of the flap are also marked. (b) Flap raised, and demonstrated at the leg donor site before transfer. Length of distal saphenous vein harvested depends on the length of radial artery required to reconstitute. (c) Flap harvested with multiple additional peripheral veins. (d) Deep aspect of flap. Saphenous vein runs through the centre of flap, with a second efferent vein harvested in the periphery of the flap
FIGURE 2
FIGURE 2
Case demonstration of a 34‐year‐old smoker, who underwent debridement of a left heel wound and calcaneal osteomyelitis and eventual reconstruction with RFFF. (a) Post‐operative day 4. Significant venous congestion + epidermolysis of proximal half of flap, managed conservatively with elevation. (b) Post‐operative day 9. Debridement of blistering revealed healthy dermis, left to heal by secondary intention. (c) Six months post‐operative. Completely healed, good soft tissue coverage and contour, with slightly thickened scar proximally where healed by secondary intention. RFFF, radial forearm fasciocutaneous flap
FIGURE 3
FIGURE 3
Case demonstration of a 19‐year‐old male who sustained significant right dorsal hand degloving injury post MVA. Underwent initial debridement and reconstruction with contralateral RFFF. He had a 15 × 6 cm soft tissue defect on the volar forearm and a 18 cm segment of radial artery harvested that was reconstituted with the arterialised saphenous flow through flap. (a) Immediate result on table after reconstituting the radial artery with the saphenous vein and two additional peripheral efferent veins anastomosed to superficial volar forearm veins to augment venous outflow. (b) Post‐operative day 4. Characteristic signs of early venous insufficiency. Resting splint is removed at this time and patient has full range of movement of wrist and long flexors. (c) Two weeks post‐operative. Healthy flap, completely healed with no signs of venous insufficiency. MVA, motor vehicle accident; RFFF, radial forearm fasciocutaneous flap
FIGURE 4
FIGURE 4
(a) Case demonstration of a 90 year old male, shown 2 months post‐operatively. Well healed donor site with no scar tissue or tethering over flexor tendons. (b) Case demonstration of a 72 year old female, shown 3.5 weeks post‐operatively. Excellent soft tissue coverage, color match, and aesthetic result for RFFF donor site. RFFF, radial forearm fasciocutaneous flap
FIGURE 5
FIGURE 5
Lower limb donor site for the arterialized saphenous flap. Minor hypertrophic scarring is noted
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