Radial lobe

Left forearm after removal of a radial flap

The radial flap (also: Chinese flap ) is a fasciocutaneous flap on the human arm that is used to cover defective skin areas in reconstructive surgery . It was first described in 1981 by Yang Kuofan.

The blood supply to the flap occurs via the eponymous radial artery , which is interrupted by the lifting of the flap. The venous outflow runs through the comitant veins , which accompany the radial artery on both sides. The sensory innervation is largely provided by the lateral antebrachial cutaneous nerve .

Indications

Depending on where the skin flap is removed , a distinction is made between proximally pedicled, distal pedunculated and free flaps. The proximally pedicled flaps are suitable for covering defects on the elbow. With the distally pedicled flaps, a soft tissue defect in the area of ​​the back of the hand, palm, fingers, thumb and wrist can be covered. Since the skin flap is supplied unchanged via the radial artery and this is not severed, no vascular sutures are necessary.

On the other hand, the free flap is completely detached and can be used anywhere on the whole body. In order to restore the blood supply, however, the separated radial artery must be vascular anastomosed to another artery in the area of ​​the defect to be covered. The radial flap is often used in the neck or head region - because, like the skin of the face and neck, it is soft and elastic; but it is also used in urology.

Both in the neck and head area and in urological reconstructions there is the additional advantage that the removal of the radial flap takes place relatively far away from the area of ​​the defect to be treated. In this way, for example, in the case of a tumor operation with planned simultaneous reconstruction, the flap can be prepared by a second team in parallel while the main operation can continue undisturbed. This results in a shorter operation time.

Complications

Before the flap can be removed, a so-called Allen test must be carried out to rule out a possible unilateral blood supply to the hand via the radial artery and the risk of gangrene of the hand. This ensures that the hand is adequately supplied with blood even after the arteria radialis has been removed via the arteria ulnaris .

The removal site is usually covered with split skin , which often produces a poor aesthetic result and can lead to wound healing disorders. Furthermore, hypoesthesia , hyperesthesia or paresthesia can be expected at the extraction site . Another complication is the decrease in strength on the donor hand. Alternatively, the defect can be covered with a full-thickness skin graft, for example from the groin region, as was done with the radial flap in the picture.

See also

• TRAM rag

literature

• Alain C. Masquelet, Alain Gilbert: Atlas of flaps in surgery of the extremities . Thieme, ISBN 978-3-432-27951-0
• Frank Hölzle , Christopher Mohr, Klaus-Dietrich Wolff: Reconstructive surgery in the face, head and neck area . In: Deutsches Ärzteblatt . tape 105 , no. 47 . Deutscher Ärzte-Verlag, November 21, 2008, p. 815–822 , doi : 10.3238 / arztebl.2008.0815 ( aerzteblatt.de [accessed on January 10, 2015]).

Individual evidence

1. ↑ Peter M. Vogt: Practice of plastic surgery. Springer, 2011, ISBN 978-3-540-37571-5 , p. 231 ( limited preview in the Google book search).
2. ↑ Andrea Rau: Deep-selective, simultaneous and non-invasive monitoring of oxygenation and perfusion of microsurgical radial and fibular transplants (PDF) Dissertation, Ruhr University Bochum, 2005.
3. ↑ Idres Afridi: Retrospective investigation of anticoagulant practices in microsurgically anastomosed transplants dissertation, University of Hamburg, 2009.
4. ↑ Frank Hölzle, Christopher Mohr, Klaus-Dietrich Wolff: Reconstructive surgery in the face, neck and head area . Ed .: Deutsches Ärzteblatt. tape 105 , no. 47 . Deutscher Ärzteverlag, Berlin November 21, 2008, p. 815-822 ( aerzteblatt.de ).
5. ↑ CM Chen, GT Lin, YC Fu, TY Shieh, IY Huang, YS Shen, CH Chen: Complications of free radial forearm flap transfers for head and neck reconstruction. ( Memento of the original from January 10, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. Volume 99, Number 6, June 2005, pp. 671-676, ISSN 1528-395X , doi: 10.1016 / j.tripleo.2004.10.010 . PMID 15897852 .