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Yamakawa et al. Plast Aesthet Res 2020;7:24 Plastic and
DOI: 10.20517/2347-9264.2020.20 Aesthetic Research

Review Open Access

Dorsal hand reconstruction with radial artery
perforator-based adipofascial flap

Sho Yamakawa, Kenji Hayashida

Division of Plastic and Reconstructive Surgery, Shimane University Hospital, Izumo, Shimane 693-8501, Japan.
Correspondence to: Dr. Sho Yamakawa, Division of Plastic and Reconstructive Surgery, Shimane University Hospital, 89-1 Enya-
cho, Izumo, Shimane 693-8501, Japan. E-mail: yamakawashoright@yahoo.co.jp
How to cite this article: Yamakawa S, Hayashida K. Dorsal hand reconstruction with radial artery perforator-based adipofascial
flap. Plast Aesthet Res 2020;7:24. http://dx.doi.org/10.20517/2347-9264.2020.20

Received: 7 Feb 2020 First Decision: 21 Apr 2020 Revised: 25 Apr 2020 Accepted: 28 Apr 2020 Published: 11 May 2020

Science Editor: Alessandro Thione Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Reconstruction of dorsal hand soft tissue defects after severe injury is challenging for surgeons. Depending on
the degree of defect, extensor tendon reconstruction may also be necessary. Various reconstruction methods are
commonly performed to cover dorsal hand defects, such as skin grafting and distant, free, or local flaps. Among
them, free vascularized flap transplantation is an ideal procedure because the major vessels that feed the local flap
may have been damaged, and the affected limb can be reconstructed using a flow-through method. Although free
flap surgery has advanced, few surgeons can choose this option due to its technical difficulty and uncertainty. On
the other hand, distant flaps have been commonly used for the reconstruction of dorsal hand defects, and local
flaps, such as reverse forearm flaps and retrograde posterior interosseous flaps, do not require microvascular
anastomosis. However, they have some problems; distant flaps require at least two surgeries, reverse forearm
flaps sacrifice major vessels and leave a scar at the donor site, and retrograde posterior interosseous flaps require
meticulous dissection of the vascular pedicle. The radial artery perforator-based adipofascial flap is a versatile flap
that is safe and easy to elevate without sacrificing the radial artery. In addition, elevating it as an adipofascial flap
enables surgeons to avoid an unacceptable donor scar. We present two cases, demonstrating the usefulness of
this pedicled perforator flap.

Keywords: Perforator, dorsal hand reconstruction, adipofascial flap, hand replantation, color Doppler ultrasonography

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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