Osteocutaneous Radial Forearm Flap Free Tissue Transfer Workup

Updated: Jan 22, 2016
  • Author: Terance (Terry) Ted Tsue, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Laboratory Studies

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  • Order electrolyte panel tests. Profound diabetes mellitus or renal failure may affect the success of free tissue transfer.

  • Obtain a complete blood cell count. Polycythemia and extreme anemia can affect flap success.

  • Measure the prothrombin time and/or activated partial thromboplastin time. The presence of coagulopathies may be a contraindication to using a free flap.

  • Order liver function tests. Liver failure is a contraindication to using a free flap. Unexplained abnormalities warrant a more extensive metastatic workup.

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Imaging Studies

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  • Plain radiographs of the forearm are required in cases of congenital deformities or when previous surgery or trauma of the forearm has occurred.

  • Angiography of the forearm to determine adequate vascular anatomy has been replaced by noninvasive studies, such as Doppler photoplethysmography, which is used when Allen test results are equivocal or routinely for all patients at some institutions.

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Other Tests

Perform the subjective Allen test in both forearms. This test ensures adequate hand perfusion by the ulnar artery and detects radial artery thrombosis. If results of the subjective Allen test are equivocal, use an objective Allen test. This technique uses Doppler photoplethysmography to detect digit perfusion under radial and ulnar artery compression scenarios. This study is most useful in showing adequate hand and digit perfusion when subjective Allen test findings are equivocal, but also used routinely for all patients at some institutions.

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