Radial Forearm Free Flap: A Modified Technique for Procurement as a Sentinel Skin Flap

BACKGROUND: Organ rejection after solid organ transplantation remains a major challenge. The sentinel skin flap (SSF), a vascularized skin flap procured from the donor and transplanted alongside solid organs, has shown promise for early detection of rejection. The radial forearm free flap (RFFF) has a long history of use in reconstructive surgery and offers distinct advantages as SSF in organ donation procedures (ODPs). Until now, the SSF has been procured using the traditional RFFF way. However, an easier, quicker, and safer way is beneficial for logistical and financial reasons. This study presents a modified RFFF procurement technique for ODPs that is simple, quick, and reproducible and can be executed by surgeons who are not familiar with the original RFFF.

METHODS: The traditional RFFF procurement technique was modified using deceased donor models, leading to the development of an SSF technique tailored for application during ODPs.

RESULTS: A modified technique was developed and presented, enabling SSF procurement to be completed within 40 min. During the procedure, the donor's arm was positioned above the head or at a 90-degree angle, allowing the creation of a sterile field without interfering with the anesthesiology or organ procurement team. Donor-site closure was achieved using running sutures, ensuring an optimal cosmetic outcome.

CONCLUSIONS: We present a modified RFFF procurement technique, designed to obtain an SSF during ODPs, that we believe can also be executed by surgeons not familiar with this flap, ensuring that the procedure does not interfere with or impede the organ procurement procedure.