The value of Allen's test in harvesting a radial forearm flap: correlation of ex-vivo angiography and histopathological findings

• Published in: International journal of oral and maxillofacial surgery 2008-07, Vol.37 (7), p.672-674
• Main Authors: Müller-Richter, U.D.A, Driemel, O, Mörtl, M, Schwarz, S, Zorger, N, Wagener, H, Reichert, T.E, Roldán, J. Camilo, MD, DMD
• Format: Article
• Language: English
• Subjects: Allen's test; Anastomosis, Surgical; angiography; Angiography, Digital Subtraction; atherosclerosis; Atherosclerosis (general aspects, experimental research); Atherosclerosis - diagnostic imaging; Atherosclerosis - pathology; Biological and medical sciences; Blood and lymphatic vessels; Bone Transplantation - diagnostic imaging; Bone Transplantation - pathology; Carcinoma, Squamous Cell - surgery; Cardiology. Vascular system; Cardiovascular system; Dentistry; Forearm - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Microsurgery; Middle Aged; Mouth Neoplasms - surgery; Otorhinolaryngology. Stomatology; Oximetry - methods; perfusion of the hand; Peripheral Vascular Diseases - diagnostic imaging; Peripheral Vascular Diseases - pathology; Radial Artery - diagnostic imaging; Radial Artery - pathology; radial forearm free flap; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radius; Reconstructive Surgical Procedures; Surgery; Surgical Flaps - blood supply; Surgical Flaps - pathology; Tissue and Organ Harvesting - methods; Ultrasonography, Doppler, Color
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2008.01.012

Abstract The radial forearm flap is one of the most commonly raised free flaps. In most cases an Allen's test is sufficient for preoperative assessment of the palmar arch, but an intact palmar arch does not imply that the radial artery is suitable for microvascular anastomosis. For a patient operated for oral squamous cell carcinoma, reconstruction was planned with a radial forearm flap. The flap had to be discarded because of advanced atherosclerosis in the presence of a negative Allen's test. The correlation of an ex-vivo angiography and the histopathologic findings was assessed. In cases of expected vascular disease, further examinations like color flow Doppler ultrasound are recommended to ensure sufficient perfusion of the radial artery.