The Radial Artery Superficial Palmar (RASP) Branch Free Flap for Finger Soft Tissue Reconstruction

The radial artery superficial palmar branch free flap is based on the perforators of the superficial palmar branch of the radial artery and its venae comitantes. This flap can be used as a sensible flap including palmar cutaneous branch of the median nerve. Forty radial artery superficial palmar branch free flaps were performed at Centum Institute during October 2010 to December 2011. There were 32 males and 8 females and their mean age were 48 years (range 30 to 66 years). The thumb injured in 13 patients, the index finger in 16 patients, the middle finger in 4 patients, the ring finger in 2 patients, and the little finger in 5 patients. The mean size of the flap was 2.5x3.5 cm(range 2x2.5 to 3x7 cm). The donor site was always closed primarily. The overall survival rate was 90.2 percent. The flaps showed well-padded tissue with glabrous skin. All patients have touch sensation and showed 12 mm two point discrimination in an average(range 8 to 15 mm). Donor site morbidity was conspicuous. One patient showed unsightly scar. Early postoperative range of motion of the affected thumb showed slightly limited radial and palmar abduction. But it improved after postoperative 2 months, and patients did not complaint limitation of motion. In conclusion, the radial artery superficial palmar branch free flap can be used as an option for soft tissue reconstruction of finger defects where local or island flaps are unsuitable.

Free Flaps for Hand Soft Tissue Reconstruction

Various soft tissue defects can be occurred in the hand. In determining the most suitable means of reconstruction a defect, the benefit of the reconstruction has to outweigh the risk of donor morbidity. Flap selection will be based on the size of the defect, the requirements for sensibility, the surgeon's comfort level, and the patient profile such as gender, age, or systemic disease. The hand is the most important tactile sensory organ, hence sensory restoration is critical. Neurosensory free flaps can provide sensibility, vascularity, and soft tissue coverage to an injured hand. This paper will discuss free flaps which can be used for soft tissue reconstruction of the hand.