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At least 1,279 records · Page 71Linked to original sources
PubMed1987

Upper limb salvage using a free radial forearm flap.

Microsurgical transfer of a skin flap salvaged from a nonreplantable upper extremity that would otherwise be discarded may provide essential soft-tissue coverage of the amputation stump, so maintaining a functional range of motion in the elbow joint. A radial forearm free flap measuring 24 cm long by 9 cm wide was salvaged from the degloved forearm skin of a patient who sustained a proximal forearm amputation that was considered unsuitable for replantation. This allowed coverage of the proximal radius and ulna, preservation of a functional elbow joint, and successful fitting of a below-elbow prosthesis.

Amputation Stumps↗
PubMed1991

A comparison of the results following oromandibular reconstruction using a radial forearm flap with either radial bone or a reconstruction plate.

Fifteen cases of oromandibular reconstruction using a radial osteocutaneous flap were compared with 16 in which the mandible was replaced with a reconstruction plate and a forearm flap was used for intraoral lining. All cases involved oral cancer; most had been irradiated. Nine survived in each group. Complications included one infected nonunion in addition to two bone exposures in the bone group, compared with three cases of plate exposure and two bone exposures in the plate group. Functional results were similar in both, but osteointegrated implants were possible only in the patients receiving bone. Cosmesis seemed somewhat better in the plate group. Donor-site problems were common but minor, and long-term forearm function was slightly reduced in both groups. Although the sample sizes were small, the reconstruction plate together with a radial forearm flap appeared to provide effective reconstruction following composite resection. However, we would not recommend this for the younger patient or in benign disease.

Adult↗
PubMed1994

The brachioradialis forearm flap: anatomy and clinical application.

The blood supply to the brachioradialis muscle and the skin of the forearm was studied in latex-injected arms. The dominant perforator to the muscle arose from the brachial artery (27.3 percent), radial recurrent artery (33.3 percent), or radial artery (39.4 percent). In all cases, adequate perforators exist from the radial artery so that transfer as either a muscle or musculocutaneous free flap based on this vessel is possible. In 10 arms the septocutaneous perforators from the radial artery were dissected to determine the relationship between the forearm and brachioradialis flaps. Transfer of the brachioradialis muscle as a free flap or combined with the radial artery forearm flap based on the radial artery and either the venae comitantes and/or the cutaneous veins is feasible. Four clinical cases demonstrate the usefulness of this flap.

Adult↗
PubMed1996

Urethral reconstruction using the radial artery forearm free flap: conventional and prefabricated.

For successful reconstruction of the scarred urethra it is logical to employ well-vascularized skin flaps. The radial artery forearm free flap is ideal for this purpose. This paper describes the first seven consecutive patients in whom we have used this flap for urethral reconstruction. In one, the forearm skin was too hirsute for urethral lining, and a prefabricated hairless skin flap was created by application of a preliminary full-thickness skin graft from a nonhairy site onto the forearm fascia. The longest follow-up is 5 1/2 years.

Adolescent↗
PubMed1998

Reliability of the venae comitantes in venous drainage of the free radial forearm flaps.

The radial venae comitantes are usually considered as an accessory venous outflow tract in the free radial forearm flap because of their smaller size and thinner structure when compared with those of the cephalic vein. To evaluate the reliability of the deep venous system, a single radial vena comitans anastomosis was performed to serve as the sole venous outflow tract in 94 consecutive radial forearm free flap transfers. The suprafascial dissection technique was used in flap elevation, which allowed preservation of the cephalic vein and the dorsal branch of the radial nerve. In all cases, the external diameter of at least one vena comitans was adequate (< or = 1.5 mm) to perform a smooth microvascular anastomosis; in none of the cases was a venous anastomosis failure detected. Preselected use of a single vena comitans for the venous drainage of radial forearm free flaps was proven to be reliable and was preferred because of the ease of flap dissection and better donor site appearance.

Adult↗
PubMed1998

Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases.

Twenty-five patients underwent soft-tissue reconstruction of the different anatomic regions of the foot and ankle using the microvascular radial forearm free flap. The patients, 19 men and 6 women, ranged in age from 3 to 80 years (mean, 48.4 years). Indications for the surgery included diabetes and/or vascular insufficiency (10 patients), trauma (9 patients), tumor (3 patients), gunshot wound (2 patients), and burn (1 patient). Osteomyelitis occurred in patients with traumatic (3 patients) and diabetic (3 patients) wounds. The weight-bearing surface of the foot was involved in eight patients. Defects ranged in size from 45 to 210 cm2 (mean, 100.4 cm2). The radial forearm flap was successful in 23 of 25 cases (92 percent). Flap complications included flap loss (two patients), infection (three patients), and minor wound dehiscence at the flap-leg skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor site complications included partial skin graft loss with tendon exposure in two patients; both healed with conservative management. Recurrent or persistent osteomyelitis was not seen in any of the patients. Of the eight patients with weight-bearing flaps, four were ambulatory, one had limited ambulation, one was nonambulatory, one had too short a follow-up, and one suffered flap loss. Two patients required modified shoes. Debulking was performed in one patient. Follow-up ranged from 2 to 72 months (mean, 24.9 months). The radial forearm flap meets most of the anatomic prerequisites for the ideal foot flap. It facilitates the restoration of normal foot contour by replacing "like-with-like," allowing patients to use normal shoes without the need for debulking (except in one patient); it provides a durable and stable weight-bearing plantar surface during ambulation; it achieves excellent aesthetic results without the dryness or cracking of the hypertrophied skin-grafted muscle; and it permits sensory reinnervation. We have found it especially useful for resurfacing the dorsum, ankle, and forefoot, moderate-sized defects, weight-bearing surfaces, and osteomyelitic wounds.

Adolescent↗
PubMed1999

Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves.

The objectives of this study were (1) to determine the extent of sensory recovery on hemitongues reconstructed with innervated radial forearm flaps and (2) to assess the influence of various clinical and surgical factors over the return of sensation, including the use of different recipient nerves for neurorrhaphy. Twenty-eight patients with tongue cancer who underwent hemiglossectomy and primary reconstruction with innervated radial forearm flaps over a 3-year period were studied. Mean postoperative follow-up was 18.2 months (range 6 to 32 months). Sensory recovery was assessed in a blind manner by two examiners that used (1) static two-point discrimination, (2) light touch sensation, (3) pain perception, and (4) hot and cold temperature perception. Different surfaces were assessed with each method on the reconstructed hemitongue and on the intact contralateral hemitongue (used as control). The following factors and their relationship with flap sensory recovery were analyzed: age, smoking history, size of the reconstructed defect, administration of postoperative radiation therapy, recipient nerve, and neurorrhaphy technique. Comparative statistical analysis (p < 0.05) between both hemitongues was performed using paired t test followed by Bonferroni correction for static two-point discrimination and light touch sensation. Fisher exact test analysis was used for pinprick and hot and cold temperature perception. The control side was ignored in analyzing the effects of the risk factors. The tip, dorsal aspect, ventral surface, and floor of mouth on the reconstructed hemitongue had comparable static two-point discrimination when compared with the intact hemitongue. Light touch sensation was also similar in the tip and dorsal aspect of both hemitongues; however, a statistically significant difference (p < 0.05) was observed on the ventral surface and floor of mouth of the reconstructed hemitongues. Likewise, pain perception was significantly decreased in the floor of the mouth, compared with other surfaces. No clearly dependent association was established between return of flap sensation and age, tobacco use, and size of the reconstructed defect. Light touch sensation, pain, and temperature perception were significantly decreased when the patients had received postoperative radiation therapy. In addition, all four sensory tests were significantly diminished (p < 0.05) when the recipient nerve used for neurorrhaphy was a nerve other than the lingual or the inferior alveolar nerve, and also when an end-to-side nerve repair was used. Sensation recovery of the innervated radial forearm flap after hemitongue reconstruction approaches normal compared with the contralateral intact hemitongue. Lower return of sensation may be anticipated in patients who receive postoperative radiotherapy. Good recovery of sensation is predictable when either the lingual or inferior alveolar nerve is used for neurorrhaphy, in contrast to using other recipient nerves.

Adult↗
PubMed1999

Penile reconstruction: combined use of an innervated forearm osteocutaneous flap and big toe pulp.

The use of a radial forearm flap has become the most popular method to reconstruct a phallus in recent years. This method of reconstruction, however, is plagued with problems such as urethral fistula and loss of phallic girth as a result of tissue atrophy, rendering a phallic contour that is cosmetically unsatisfactory. We had the opportunity of modifying the technique of penile reconstruction using a forearm osteocutaneous flap to minimize these problems. Specifically, a segment of the big toe pulp is used to reconstruct a glans penis. Sensory restoration in the "glans" and "penile shaft" is restored by coapting the digital and the antebrachial nerves to the penile nerve remnants. A segment of flexor carpi radialis muscle is included in the design of a forearm flap to reinforce the coaptation site of the urethral tract. An arteriovenous shunt is incorporated in the shaft as a mechanism to elicit erection of the penis by compressing the root of the neophallus. We had used these technical modifications in a 51-year-old man who had undergone penile amputation because of cancer. The cosmetic appearance and erotic and tactile sensation in the shaft and glans were proper and satisfactory at the end of fourth year after the surgery. The coital function was also satisfactory.

Amputation, Surgical↗
PubMed2000

Anatomic study of the venous drainage architecture of the forearm skin and subcutaneous tissue.

The venous anatomy of the forearm skin was examined radiographically in 15 fresh cadavers that had been injected systemically with a lead oxide-gelatin mixture. In 10 specimens, the forearm skin was divided into the skin and superficial adipofascial layer and the deep adipofascial layer. Five specimens were radiographed stereoscopically. Despite the thinness of the skin and subcutaneous tissue of the forearm, the cutaneous vein was seen three-dimensionally. Judging from the architecture and direction of the venous valves, most of the venous blood that had perfused the dermis was believed to: (1) pool in a venous network located in the superficial zone of the skin and subcutaneous tissue, (2) flow chiefly in the accessory cephalic and median antebrachial veins, and (3) enter the cephalic and basilic veins near the antecubital fossa. Venae comitantes of the septocutaneous and musculocutaneous perforators of the radial or ulnar arteries were thought to be only bypasses to the deep vein.

Fascia↗
PubMed1981

Forearm plethysmography in normotensive and hypertensive pregnant women.

Forearm plethysmography affords a simple noninvasive method of studying dynamic changes in the microcirculation. This technic was used to study the peripheral circulation of normotensive nongravid women and normotensive and untreated hypertensive pregnant women during the third trimester. The variables of forearm blood flow, vascular resistance, venous capacitance, and capillary filtration coefficient were measured in the resting state and during and after exercise. The pregnant women demonstrated an increase in forearm blood flow over the nonpregnant women. As expected, vascular resistance was higher in the hypertensive pregnant patients than in normotensive pregnant women. The possible predictive value of these findings is discussed.

Female↗
PubMed1986

Total parathyroidectomy and forearm autotransplantation for chronic renal failure: a useful tool for the general surgeon in private practice.

We reviewed 12 cases of chronic renal failure in patients with secondary hyperparathyroidism who had total parathyroidectomy and forearm autotransplantation during the years 1978 to 1984. All had elevated parathyroid hormone and calcium levels before the procedure. Using a technique previously described, with relatively large parathyroid grafts in the forearm, calcium levels were effectively reduced and maintained below the upper limit of the normal range (10.5 mg/dl). Only one patient had symptomatic hypocalcemia postoperatively. Phosphorous levels were also significantly reduced to more physiologic values. When necessary, the forearm autografts allowed simplified titration of calcium levels on an outpatient basis.

Adult↗
PubMed1986

Forearm neuropathy and pruritus.

Five adult patients (four of them men) had episodic brachioradial pruritus associated with forearm paresthesia and hypalgesia. No cervical, shoulder, or forearm trauma was known. Onset was variable, but two had had the condition for more than ten years. In each, sensory alteration was detectable by pinprick and temperature in the distribution of the posterior cutaneous nerve of the forearm supplying the skin over the proximal portion of the brachioradial muscle. This seems to be a benign neuropathy.

Adult↗
PubMedDate not supplied

A comparative study on the predictive value of digital subtraction angiography and B-mode ultrasonography in evaluating arterial injury in high-voltage electrical burn of the forearm.

To compare the predictive value of digital subtraction angiography (DSA) with B-mode ultrasonography in evaluating the arterial injury in high-voltage electrical burn of the forearm, 19 forearms sustaining high-voltage electric burn were examined with DSA and B-mode ultrasonography. During surgery, the involved arteries were examined closely to compare their gross pathology with the results of DSA and B-mode ultrasonography. The thrombotic or necrotic arteries found during surgery were excised and examined pathologically. Among 19 ulnar and radial arteries examined by DSA and B-mode ultrasonography, the abnormal signs were found in 14 ulnar and 11 radial arteries in DSA, including narrowing of lumen, beading of the wall, thrombosis, and slowing of blood flow, whereas abnormal signs were shown by B-mode ultrasonography in 19 ulnar and 16 radial arteries, including roughening, edema or exfoliation of the endothelium, thickening of vessel wall, narrowing of lumen, beading of the wall, and decrease in the blood flow. The vessels with severe injuries showed thrombosis or necrosis of the vessel wall. The aforementioned changes were confirmed during surgery and pathologic examination. B-mode ultrasonography is a more efficient tool than DSA in evaluating vascular injuries of the forearm sustaining high-voltage electrical burn.

Adult↗
PubMed2004

Forearm supination deformity after obstetric paralysis.

We retrospectively evaluated 66 patients who had radius osteotomies (44 patients; average age, 79.9 months) or soft tissue procedures (22 patients; average age, 57.4 months) to improve persistent supination at rest secondary to obstetric brachial plexus lesions and select the optimal treatment indication for each patient. Followups averaged 64.3 months and 72.57 months, respectively. In the osteotomy group there was a significant difference when preoperative supination at rest (average 31 degrees), intraoperative pronation obtained (average 114 degrees), and position of the forearm at last followup (average 92 degrees), were compared, whereas in the soft tissue procedures group there was not a significant difference between intraoperative pronation obtained (average 116 degrees) and forearm position at rest at last followup (average 108 degrees). Shoulder function was not affected by any of these interventions. Elbow extension was decreased at the last followup in both groups. Wrist and finger extension were improved in both groups. Complications included two delayed unions, one nonunion, and nine recurrences, all secondary to radius osteotomies. The procedure of choice for each patient must be based on preoperative forearm motion, condition of the proximal and distal radioulnar joints, triceps function, deformities of the shoulder and elbow, and hand function.

Brachial Plexus Neuropathies↗
PubMed2005

Impaired forearm rotation after tension-band-wiring fixation of olecranon fractures: evaluation of the transcortical K-wire technique.

The tension-band-wiring technique is a well-accepted method of internal fixation of olecranon fractures. In addition, it is suggested that transcortical placement of the k-wires results in lower rates wire migration. We encountered two clinical cases in which transcortical placement of the k-wires led to impairment of forearm rotation. An anatomic study was conducted to study the effect of transcortical wire placement to avoid similar future complications. Using specimens from 10 embalmed cadavers, we found that transcortical wires inserted in <30 degrees of ulnar angulation in the coronal plane to the medial ridge of the olecranon, impinged on the radial neck, supinator muscle, or biceps tendon. This was avoided in all 10 specimens when the wires were inserted, with the forearm in supination, at 30 degrees of ulnar angulation. We recommend this technique to be adopted to avoid forearm rotation impairment.

Bone Wires↗
PubMedDate not supplied

Closed treatment of displaced diaphyseal both-bone forearm fractures in older children and adolescents.

The management of adolescent radius and ulna diaphyseal fractures is controversial. The purpose of this study was to address the residual deformity and functional outcome following closed treatment of these fractures. Twenty-five older children and adolescents (mean age 13.3 years, range 8.8-15.5) with displaced diaphyseal both-bone forearm fractures underwent closed treatment and were followed for a mean of 49.6 weeks. All fractures united. On the final AP radiograph, the mean angulation was 9 degrees (range 0-18 degrees) for the radius and 8 degrees (0-20 degrees) for the ulna. All patients achieved full elbow and wrist range of motion. Loss of forearm supination and pronation averaged 4 degrees (range 0 to 20 degrees) and 6.8 degrees (0 to 40 degrees), respectively. Closed reduction and casting of displaced both-bone diaphyseal forearm fractures, despite the residual angulation, results in satisfactory functional outcome and should remain a viable treatment option in the management of this injury.

Adolescent↗
PubMedDate not supplied

The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?

Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. All Caucasian and African-American patients who underwent a closed reduction of a fractured ulna or radius over the 2-year observational period were enrolled. Patients were excluded from the study if they were admitted to the hospital for an open reduction or had multiple injuries. The relationship between race, gender, insurance status, time of admission, length of stay in the emergency department, fracture characteristics, and the use of conscious sedation was analyzed. t tests, chi-square tests, and stepwise logistic regression were used for data analysis. A total of 503 patients were included, 83% Caucasian and 17% African-American. Four hundred four patients received conscious sedation as part of their fracture reduction procedure and 99 did not. Univariate analysis showed that African-American and Caucasian children had different forearm fracture patterns (P = 0.0116) and different severities of angulation (P = 0.0094). Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.

Adolescent↗
PubMed2004

Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap.

OBJECTIVE: To assess the results of the use of the free radial forearm flap in terms of objective morbidity and subjective patient response. STUDY DESIGN: The donor sites were examined from 37 patients who underwent reconstruction with a free fasciocutaneous radial forearm flap in the head and neck after ablative tumor surgery. METHODS: Patients were asked to fill in a written questionnaire. The following additional tests were performed: resting skin temperature of digits I and V, temperature after submersion in iced water, grip and pinch tests, and goniometry. RESULTS: Resting skin temperature was slightly decreased for donor hands 0.69 degrees C (P < .001) and 0.31 degrees C (P = .048) for digits I and V, respectively, but recovery after submersion in iced water showed no differences. The strength tests and goniometry revealed no statistically significant findings between donor and control sides. On the questionnaire, 9 patients (24%) reported slightly impaired function, 14 (38%) could not wear their watch or bracelet, 17 (46%) reported numbness, 5 (14%) reported soreness, 5 (14%) reported itching, 6 (16%) reported cold intolerance, 5 (14%) reported bad cosmetic appearance, and 9 (24%) expressed the opinion that they were insufficiently counseled. CONCLUSION: There is a negligible objective morbidity of a free radial forearm flap harvest procedure, but a number of patients have subjective complaints when asked. Elaborate presurgical counseling can probably reduce these complaints.

Adult↗