THE RADIAL FOREARM FLAP DONOR SITE - SHOULD WE VEIN GRAFT THE ARTERY - A COMPARATIVE-STUDY

Controversy exists in the literature regarding reconstruction of the radial artery after elevation of the radial forearm flap. The literature suggests that reconstructing the radial artery with a vein graft is an important aspect in the use of this flap. In our experience, this has never been performed with no sequela. We examined 13 consecutive patients who underwent radial forearm flaps for head and neck reconstruction over a 28-month period. The patients were examined and questioned about the function of their upper extremities in hope of evaluating the postoperative vascular status in each. Median follow-up was 6 months, with a range of 1 month to 24 months. No patient had preexisting trauma or congenital abnormality of either arm, so that the nondonor arm could be considered as a control for each patient. Evaluation consisted of history and physical examination. The following parameters in each patient were carefully accumulated: grip strength, cutaneous blood flow measured by using a laser Doppler flowmeter, transcutaneous oxygen levels, digital/brachial blood pressure ratios, cutaneous temperature from thumb/index and thumb/small pinch, and rapid rewarming at 1-minute and 5-minute intervals after cold immersion for 2 minutes. The radial forearm flap was elevated in each patient in the nondominant extremity. Grip strengths ranged from 19 to 77 kg, with a median of 30 kg. Early rewarming of the thumb/index was also an average of 1.5-degrees less than the temperature in the control arm and was statistically significant to (p = .01). Early rewarming at 1 minute showed a median temperature of 18.3-degrees-C as compared to 19.8-degrees-C in the control arm between thumb and index finger (p = .01). However, late rewarming by 5 minutes showed all digital temperatures not statistically different in each hand. Resting basal temperature was similar on each side. Digital/brachial pressure indexes of the thumb and long and small fingers were also not statistically significant between both hands, and laser Doppler flow in all of these digits also was not statistically significant. On the basis of the above studies and in contrast to current suggestions in the literature, we feel that this study adds further credence to the belief that as long as cross-flow is present within the vascular arches of the hand, reconstruction of the radial artery is not necessary in using the radial forearm flap. We have utilized this flap in over 60 patients and will continue to use it in our reconstructive cases without vein-grafting the radial artery donor site.