INTRODUCTION: The purpose of this study was to analyze the indications for use of the radial forearm flap in reconstruction of the upper extremity and to document any complications with the flap or donor site.

MATERIAL AND METHODS: 54 radial forearm flaps were performed for upper extremity reconstruction by a single surgeon. 43 were pedicled and 11 were free flaps from the contralateral extremity (9) or Ipsilateral extremity (2). Of the 43 pedicled flaps, 32 were designed on reverse flow in the radial artery and 11 were based on antegrade flow. Six flaps were elevated as radial forearm fascial flaps. The flaps were indicated for soft tissue coverage of the elbow (9), dorsal wrist and hand (13), palmar wrist and hand (7), thumb-index finger web space (5), and for coverage of thumb amputations (4). Pedicled or free radial forearm flaps were used for reconstruction after radical resection of malignant tumors of the hand or wrist in 10 patients. More esoteric indications included circumferential wrapping of the median, ulnar and radial nerves for traction neuritis (5) after release of radio-ulnar synostosis (1) and prior to pediatric toe-to-hand transfers (2).

RESULTS: Transfer of the radial forearm flap and healing of the defect was successful in 96% patients. There was partial peripheral loss of one reverse radial forearm flap probably due to venous problems in a patient with necrotizing fasciitis and complete loss of one free radial forearm flap in a patient who had been heavily irradiated. Eight donor sites were closed primarily, 46 were covered with a non-meshed split thickness skin graft. There was 100% “take” of the split thickness skin graft on the donor defect in these 46 patients. No patients complained of cold intolerance of the hand or altered sensibility or dysthesias in the superficial radial nerve or lateral antebrachial nerve distribution.

DISCUSSION: This is the largest reported series of radial forearm flaps for reconstruction of the upper extremity. The antegrade pedicled radial forearm flap is unquestionably the flap of choice for coverage of defects around the elbow. The reverse radial forearm flap or contralateral free radial forearm flap is more versatile than the groin flap and more reliable than the posterior interosseous artery flap for coverage of moderate sized defects of the dorsal or palmar wrist and hand and is specifically indicated for release of the thumb-index finger web space and for coverage of amputations of the thumb in preparation for toe-to-thumb transfer.