Fashioning reversed axial pattern forearm tissues in different challenging conditions of the forearm territory as a reliable substitute for free tissue transfer.

AIM: Traumatic tissue defects, chronic ulcerations, burn contractures and post-oncological excisions are the main problems affecting the hand and forearm areas. This work addresses the question of whether reversed axial island flaps from the forearm area could be applicable to any form of soft tissue defects in the territory of the forearm, and whether they could be considered reliable substitutes for free tissue transfer.

METHOD: Thirteen patients who sought surgical treatment for soft tissue defects of the hand, wrist, and distal forearm regions were included in this evaluation report. The patients complained of four different etiologies, and their resultant tissue defects were managed by reversed radial forearm flap in eight cases and by the ulnar variety of the reversed forearm flap in another five cases. Selection of the flap option depended on the site of the pathology, size and thickness of the resultant defect, special needs of the defect, vascular limitations, and the like-tissue reconstruction objective.

RESULTS: All flaps survived well with no complications. Both donor and recipient sites healed successfully. The selected flaps were ideal in their specific application. Harvesting reversed forearm flaps does not require high surgical skills or special equipment, venous congestion is less significant than with free flaps, and the patients do not need intensive immediate postoperative care and supervision.

CONCLUSION: This is an easy and reliable technique requiring short operating time, and initiation of early physiotherapy is permitted, making forearm flaps reliable substitutes for free flap applications with all the associated complications.