Radial Artery Fascial Free Flap with Vascular Donor Reconstruction: A Low-Cost, Versatile Reconstructive Choice

Use of radial artery free flaps for large defects is not popular because of the unacceptable grafted donor defect. Choice of the radial artery fascial free flap leaves only a palmar linear forearm scar, provides a larger vascularized flap, allows “macro-micro” easy vascular anastomoses for old surgeons, and permits vein graft radial artery reconstruction leaving minimal donor cost. Nonetheless, temporalis, arm, and back fascial free flaps seem more popular, and published use of the radial artery fascial flap has been as a pedicle flap with some difficulties thought due to reverse venous flow. Free flap use obviates this problem. Six arm and leg cases were chosen to illustrate the ease, versatility, and technical suggestions for use of radial artery fascial free flaps.

Case examples included circumferential late wrist reconstruction with palmar contracture release; proximal carpectomy; extensor tendon grafting following train injury; hand dorsum reconstruction with extensor tenolysis in a fisherman who fell into a chum bucket with subsequent vibrio septic shock and necrosis; two Achilles tendon coverage cases; one heel reconstruction over exposed calcaneal avulsion; and one osteomyelitis with exposed tibial plate and bone graft.

All flaps survived with primary take of skin graft on the free flap, although one skin graft over the Achilles proved unstable and was regrafted with full thickness skin. All reconstructed radial arteries remained patent up to a 10-year follow-up.

The radial artery fascia provides an underutilized free flap the size of the entire palmar forearm, particularly useful over tendon gliding surfaces of large defects. Reconstructed radial arteries remained patent and the grafts durable, even on the heel.