Combined dorsal forearm and lateral arm flap.

The free latissimus dorsi musculocutaneous flap and the free groin flap have been used for the coverage of medium- to large-sized soft-tissue defects in the hand. However, these are often too bulky for the hand, requiring secondary operation for thinning. We have used the dorsal forearm flap combined with the lateral arm flap for the coverage of large soft-tissue defects in the hand. This flap is based on the reversed vascular pedicle of the posterior interosseous artery. The posterior radial collateral branch of the profunda brachii artery is then anastomosed to the recipient vessel to augment the vascular supply to the lateral arm flap. We have used this combination flap in two clinical cases and achieved one-stage soft-tissue reconstruction of the hand.