Reverse radial forearm flap peforator used in digital revascularization.

There are very few reports in the literature of using pedicled flaps to revascularize distant tissue. Here, we describe the first description of using a radial artery perforator from a reverse radial forearm flap to revascularize a digit. Complex hand trauma presents multifaceted problems for the surgeon. This is illustrated by a recent case we treated of a severe hand crush injury, in which the two main problems were finger devascularization and a palmar defect. This required vein graft revascularization and local flap reconstruction. The initial management failed, and instead of repeating the same procedures, a single elegant solution was found. A reversed radial forearm flap was used for soft tissue defect coverage of the palmar defect, while a radial artery perforator was isolated for digital revascularization. This technique may seem excessive for digital revascularization, but in the correct context it overcomes "zone of injury" issues in major hand trauma and allows simultaneous revascularization with soft tissue defect cover.