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adipofascial_radial_artery_perforator_flap

Adipofascial Radial Artery Perforator Flap

Case series

2015

Samson et al report the use of the radial artery perforator based adipofascial flap in nine patients, five with rigid radioulnar synostosis, three with recalcitrant carpal tunnel syndrome and one with a soft tissue defect.

All the patients with radioulnar synostosis regained good functional rotations of the forearm with no recurrence at follow up. The patients with recalcitrant carpal tunnel also had resolution of symptoms with no recurrence. The flap healed well in all the patients.

They propose this flap as a viable, versatile reconstructive option for the hand and upper limb 1)

2014

Between 2004 and 2010, 8 patients, who had a mean age of 37 years, and who had posttraumatic painful median nerve neuromas at the level of the wrist but with retained median nerve function . All of them reported neuropathic pain and had a positive Tinel's sign over the site of the presumed neuroma. The surgical procedure included external neurolysis and coverage with an ulnar artery perforator adipofascial flap (4 patients) or with a radial artery perforator adipofascial flap (4 patients). Patients were reviewed after a mean follow-up of 41 months (range, 18-84 mo). Preoperative and postoperative pain was measured with a visual analog scale.

Pain improved from a preoperative mean value of 7.8 to a postoperative mean value of 3.6. There was complete resolution of pain in 5 patients, mild pain persisted in 2 patients, and 1 patient reported no improvement. No complications occurred at the donor site.

Vascularized soft tissue coverage of painful median nerve neuromas is an effective treatment. They do not believe that a free flap is of any particular advantage over a local pedicle flap which they suggest using to protect the median nerve 2).

Case reports

2014

47-year-old man who presented with polytrauma following a fall from a roof in March 2011. He sustained a head injury and a complex, comminuted forearm fracture. He underwent an open reduction and internal fixation of the fracture at the time of injury, but later developed a rigid type 2 diaphyseal radioulnar synostosis, with loss of forearm rotation. Synostosis excision and a radial artery perforator-based adipofascial interposition flap to prevent recurrence has resulted in a good functional outcome and no recurrence at 2.5 years follow-up 3).

2009

A clinical report of an extensive dorsal hand traumatic soft tissue injury where a new ultrathin oblique volar-to-dorsal adipofascial reverse turnover flap based on radial artery distal perforators is presented. Its width-to-length ratio was 1:4 (the longest ever reported), designed to cover primary free tendon grafts and exposed metacarpal bones.

The technique has provided very good hand function and cosmetic outcome, minimum donor site morbidity, shortened rehabilitation, and no complications.

Adipofascial flaps constitute a functional and an aesthetic refinement in the reconstructive surgical techniques managing complex tissue defects of the dorsum of the hand, a new surgical strategy reported here 4).

References

Adipofascial turnover perforator flap for dorsal hand reconstruction based on both the posterior interosseous artery and radial artery 5).

1)
Samson D, Power DM. The Adipofascial Radial Artery Perforator Flap: A Versatile Reconstructive Option in Upper Limb Surgery. Hand Surg. 2015 Jun;20(2):266-72. doi: 10.1142/s0218810415500227. PubMed PMID: 26051767.
2)
Adani R, Tos P, Tarallo L, Corain M. Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps. J Hand Surg Am. 2014 Apr;39(4):721-7. doi: 10.1016/j.jhsa.2014.01.007. Epub 2014 Feb 25. PubMed PMID: 24576755.
3)
Samson D, Power D, Tan S. Adipofascial radial artery perforator flap interposition to treat post-traumatic radioulnar synostosis in a patient with head injury. BMJ Case Rep. 2015 Feb 27;2015. pii: bcr2014207659. doi: 10.1136/bcr-2014-207659. PubMed PMID: 25725026.
4)
Al Hoqail R. Ultrathin oblique volar-to-dorsal reverse turnover radial artery perforator-based adipofascial flap: a new surgical strategy for reconstructing a complex dorsal hand tissue defect. J Craniofac Surg. 2009 Nov;20(6):2221-4. doi: 10.1097/SCS.0b013e3181bf84f2. PubMed PMID: 19884830.
5)
Adipofascial turnover perforator flap for dorsal hand reconstruction based on both the posterior interosseous artery and radial artery.
adipofascial_radial_artery_perforator_flap.txt · Last modified: 2015/07/31 08:15 (external edit)