Patency of Radial Artery Reconstructions after Radial Forearm Flap Harvest

The sacrifice of the radial artery in the harvest of the radial forearm flap can be a deterrent to the use of this flap. The need for reconstruction of the radial artery in this setting has been debated. Historically, low patency rates are cited in arguments against reconstruction. The authors' clinic routinely reconstructs the radial artery with reversed interposition vein grafts after flap harvest. The purpose of this study was to evaluate the patency rates of these reconstructions.

A two-team approach was used for the harvest and inset of all radial forearm flaps. Flap inset and anastomoses and radial artery reconstruction with reversed, cephalic, basilic, or saphenous vein grafts, were performed simultaneously. Anastomoses were performed using 8-0 or 9-0 nylon suture and an operating microscope. Patients who had undergone radial forearm flap harvest and radial artery reconstruction at the Buncke Clinic were identified. Direct palpation, Allen's test, 2-D ultrasound, and color Doppler flow imaging (SonoSite, Bothell, WA) were used to assess the patency of the reconstructed radial artery. The diameters of the native artery, proximal and distal to the vein graft, and the proximal, middle, and distal portions of the vein graft were measured with 2-D ultrasound.

Of 18 patients who met the inclusion criteria, six were available for examination. Follow-up ranged from 7 to 65 months (mean = 29 months). All arterial reconstructions were patent by palpation, Allen's test, 2-D ultrasound, and color Doppler imaging. The mean diameters of the proximal and distal native radial artery were 2.5 mm and 2.0 mm, respectively. The mean diameters of the proximal, middle, and distal portions of the vein graft were 3.5 mm, 3.3 mm, and 3.6 mm, respectively.

In the reported series, reconstructed radial arteries had a 100% patency rate and no incidences of stenosis. The authors therefore believe that radial artery reconstruction can be performed with the expectation of patency. With the use of two surgical teams, reconstruction does not add to total operative time. They presently perform arterial reconstruction in an attempt to restore normal physiology and provide a second forearm artery to insure flow to the hand in the case of subsequent injury or disease of the ulnar artery. The reconstruction also provides additional opportunities for teaching microsurgery to residents and fellows.