Radial Artery Perforator Flap

Soft tissue defects in the hand and wrist can be challenging problems for the hand surgeon. The retrograde radial forearm fasciocutaneous flap has emerged in recent years as the workhorse flap to cover many hand and wrist defects. However, recognition of the intrinsic limitations of this flap has led to the development of other alternative flaps to provide soft tissue coverage for this region. The radial artery perforator flap has many of the benefits of the radial forearm flap but minimizes the disadvantages, such as the need to sacrifice the radial artery, color and bulk mismatch of the flap and recipient tissues, and donor site appearance. In this article, we will review the indications for using the radial artery perforator flap to cover hand and wrist soft tissue defects. We will discuss the surgical anatomy, indications, operating technique, rehabilitation protocol, potential complications, and pearls and pitfalls for use of this flap for upper-extremity defects.