Decision Making in Skin Paddle Design of Pedicled Radial Forearm Flap

The Elbow is one of the functional big joints that is at risk of trauma, especially during traffic accidents. Although the reconstruction ladder is the priority, regional flaps have some advantages, including pliable tissues, being far from the danger zone of trauma, and having sufficient tissue. A 32-year-old man who suffered severe injury to the upper limb was referred for reconstruction. The fractured elbow had a plate that should be covered with sufficient soft tissue and skin. Proximally based fascio-cutaneous forearm flap, designed and harvested preserving perforators, and transferred safely. There are small septocutaneous perforators from the radial artery to the wrist skin. Fine microscopic dissection should be done to preserve this perforator to achieve a small skin paddle for harvest on the distal part of the wrist. The radial forearm flap should be considered in elbow skin defects. This proximally based flap has robust nourishment and can be harvested safely.