The reverse radial forearm flap in the severely injured hand: an anatomical and clinical study.

An anatomical study in 25 cadaveric upper limbs quantified the communications between the radial and ulnar arteries immediately proximal to the carpus. These studies suggest that the reverse radial forearm flap can safely be used in severe hand trauma where reliable pre-operative assessment of the palmar collateral circulation is not possible. It is recommended that the pedicle is pivoted 4 cm from the styloid process at which point there is a 96% probability of leaving the superficial palmar branch and one other communication intact and a 77% probability of leaving two other communications intact. Two clinical cases are outlined for illustration.