title: Free distal volar forearm perforator flap: clinical application in digital reconstruction.
abstract: BACKGROUND
  Soft tissue defects of the digits can be a challenging problem for the hand surgeon. For non-graftable defects, numerous local, regional and free flaps have been described for resurfacing, each with their own limitations - bulk, colour, texture mismatch, donor morbidity. Perforator flaps increasingly provide the optimal option for reconstruction of digital defects as they are thin, pliable and with low donor site morbidity.
  
  
  METHODS
  A thin, pliable fasciocutaneous flap can be raised from the distal volar forearm based on a perforator of the radial artery. The pedicle is up to 2-3 cm in length with a diameter of at least 0.5 mm in diameter, suitable for anastomosis to the digital artery. Venous drainage is via the venae comitante of the radial artery and superficial volar veins.
  
  
  RESULTS
  A patient presented to our emergency department following circular saw injuries. He suffered multi-digit trauma with subsequent soft tissue defects over the dorsum of the digit. Reconstructive requirements were met utilizing a free fasciocutaneous flap raised on a distal volar forearm perforator from the radial artery. The recovery was uneventful with no donor site morbidity.
  
  
  CONCLUSIONS
  Dorsal digital soft tissue reconstruction requires thin, pliable, ideally hairless and sensate skin. Most locoregional options are limited by the need for multi-stage surgery, bulk, limited reach or donor site morbidity. In our patient, the reconstructive requirements were met with preservation of the radial artery. While it requires microsurgical skill and instruments, this flap provides another option for the reconstructive hand surgeon.
authors.affiliation: Barwon Health, Department of Plastic, Reconstructive and Hand Surgery, Geelong Hospital, Geelong, Victoria, Australia.
authors.forename: Chasari
authors.initials: C
authors.lastname: Tancharoen
authors.forename: Vachara
authors.initials: V
authors.lastname: Niumsawatt
authors.forename: Edmund W
authors.initials: EW
authors.lastname: Ek
authors.forename: Damon J
authors.initials: DJ
authors.lastname: Thomas
mesh_terms: D000061:Accidents, Home; D000328:Adult; D000792:Angiography / Q000379:methods; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005542:Forearm / Q000098:blood supply / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D021621:Imaging, Three-Dimensional; D015601:Injury Severity Score; D008297:Male; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: flap; hand trauma; reconstruction