PMC9512133_01
The patient's left forearm and scars due to previous self-inflicted wrist laceration are shown in 1A; similar scarring was seen on the right dominant arm. Preoperative planning of RFFF design including planned dimensions of flap and course of radial artery proximally are shown in 1B.
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However, she presented a unique and previously unreported challenge associated with the use of a RFFF or UFFF with her history of self-inflicted forearm lacerations, shown in Figure 1A. The typical design of the RFFF was adjusted for this patient so as not to include any of the scarred epidermis and dermis that resulted from her previous suicide attempt shown in Figure 1A. Preoperative RFFF design planning for this patient is shown in Figure 1B. A 9 by 7 centimeter flap was marked out to include the left radial artery and cephalic vein as shown in Figure 1B.
Intraoperative photo showing RFFF harvest after lifting the flap from native tissue and dissecting out the vascular pedicle prior to its division. Demonstrates the individualized design of this patient's flap, the flap was moved about 4 cm proximally to avoid inclusion of the patient's scarred epidermis and dermis.
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The RFFF is shown in Figure 2 intraoperatively prior to vascular pedicle division.
Intraoperative LAIGA image prior to vascular pedicle division demonstrating progressive perfusion of the RFFF from 3A to 3B and viability of the entire skin paddle. The RFFF is pictured within the yellow rectangle in the same orientation as Figure 2. Increasing white intensity correlates with increasing perfusion of the tissue, the square marks the most proximal perforator.
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Progressive and adequate perfusion to the distal edges of the flap was observed as shown in Figures 3A and 3B, confirming flap viability. The medial superior edge of the flap marked by a square in Figure 3A contained the most proximal perforator harvested, perfusion from that perforator advancing throughout the entire skin paddle is shown from Figure 3A to 3B. Perfusion of the entire flap was demonstrated by LAIGA as shown in Figure 3B, proving its viability.
Six-month postoperative photo demonstrating favorable healing of the RFFF in 4A within the oral cavity and of the forearm donor site which was able to be closed primarily in 4B.
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She continues to do well showing good healing of her recipient and donor sites at clinic visits to date up to four months postoperatively as shown in Figure 4.