Radial Forearm Flap versus Radial Adipofascial Perforator Based Flap for Reconstruction of Hand Soft Tissue Defects

Background: Reconstruction of soft tissue defects of the hand possesses a challenge to the plastic and reconstructive surgeons. In recent years, the radial forearm fasciocutaneous flap has been used extensively to cover hand soft tissue defects. With the routine use of this flap some drawbacks have become apparent. The need to sacrifice the radial artery during the harvest of the flap and the donor site morbidities. The limitations of the radial forearm flap and further understanding of the vasculature of the forearm have led to the development of other pedicled forearm flaps based on the perforators from the radial, artery. This study aimed to compare the radial forearm flap with the radial adipofascial perforator based flap for reconstruction of hand soft tissue defects. Methods: This study included twenty patients with post-burn and post-traumatic soft tissue defects in the hand were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: Group A(Chinese flap group) for whom distally based radial forearm flap was used for coverage of hand soft tissue defects and group B(Perforator flap group) for whom distally based radial adipofascial perforator based flap was used. Operative time, length of hospital stay, incidence of complications, donor site morbidity and patient satisfaction were assessed for all patients. Results: There were no significant differences between both groups as regard to age, sex, aetiology and site of soft tissue defects. On the other hand, the operative time (68±3.4 mins versus 80±4.2 mins), length of hospital stay (8.8±0.8 days versus 13.6±1.5 days) and the incidence of complications (30% versus 80%) decreased significantly in the Chinese flap group versus the perforator flaps group. While there was an increase in the cosmetic satisfaction in the perforator flaps group, but didn't reach the significant level (p=0.074). Conclusion: Distally based radial forearm flap remains the cornerstone for reconstruction of hand soft tissue defects with acceptable cosmetic results and low incidence of complications provided that adequate preoperative vascular assessment. The radial adipofascial perforator based flap is a new innovative technique requires further anatomic studies for more accurate assessment of the forearm perforators with their angiosome distribution and regarding the matter of immediate or delayed skin graft, it is obvious that delayed grafting has superior results but further evaluation studies are recommended.