Shape-Modified Radial Forearm Perforator Flaps for Reconstruction of Soft Tissue Defects

The modern version of using vascularized flaps as perforator flaps has considerably expanded opportunities to perform reconstructive surgery. The radial forearm flap, described in China in 1978, has been widely used in reconstruction of scalp and oral defects. However, the radial forearm flap has two disadvantages that limit its use. The donor site is not always aesthetically acceptable, especially if a skin graft has to be used for coverage. In order to overcome this problem, the authors have developed a shape-modified method (SMM) of the radial forearm perforator flap.

From 1992 to 2003, 135 patients with soft tissue defects were treated by transfer of a radial forearm perforator flap using the shape-modified method. The shape of the flap is an ellipse with a maximum width of no more than 5 cm in its proximal part, 4 cm in its middle part, and 3 cm in its distal part. These dimensions and shape are necessary for primary closure of the donor site by cosmetic sutures. Then, a cross or oblique section of the flap is performed up to the radial vessels per anatomic location of the perforator vessels. Thus, the radial forearm perforator flap is split into two or more fasciocutaneous components supplied by the perforator vessels. These flaps can be moved along with the perforator vessels to fit the shape of the soft tissue defect. All patients had complete survival of the transplanted radial forearm perforator flaps.

When the shape-modified method is used, the ellipse shape of the radial forearm perforator flap can be challenged to fit a soft-tissue defect shape. Furthermore, the donor site can be closed primarily using cosmetic sutures.