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Yamakawa et al. Plast Aesthet Res 2020;7:24 I http://dx.doi.org/10.20517/2347-9264.2020.20 Page 3 of 11

A B

Figure 1. A, B: illustration of radial artery perforator-based adipofascial flap elevation, including connection of both perforators to the
subdermal vascular network in the proximal and distal ends of the forearm. This flap can be elevated and transferred to the defect of the
dorsal hand safely

A B

C D

Figure 2. Procedure of radial artery perforator-based adipofascial flap elevation (From Case 1 in this article). A: the radial forearm
adipofascial flap was designed along the radial artery. Red circle indicates pivot port; B: the adipofascial flap was elevated, preserving
perforators at the distal end of the flap; C: once elevated, the flap was turned over or rotated to reach the dorsal defect; D: the donor site
was closed and a skin graft was applied over the flap

4. Transfer the flap through the subcutaneous tunnel to the dorsal hand defect [Figure 2C].

5. Resurface the transferred fascial flap on the dorsal hand with a split-thickness skin graft [Figure 2D].
Elevate the affected arm and bandage with slight pressure to avoid postoperative congestion.