Reverse Superficial Palmar branch of Radial artery pedicled flap for Palmar and Digital reconstruction: A systematic review of literature with a retrospective case review

BACKGROUND: Most studies on the superficial palmar branch of radial artery (SUPBRA) flap involve its use as a free flap with only few reports in literature regarding its use as a reverse pedicled flap. This systematic review presents a summary of the available literature on the indications, anatomy, technique, complications and outcomes of the reverse SUPBRA flap and also describes our experience. METHODS: A computer search was performed on the Embase, Medline and Pubmed databases for clinical studies describing the reverse SUPBRA flap in accordance with the standard principles for systematic review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A retrospective review of cases performed by the senior author was also conducted. RESULTS: Seven studies qualified for the review with 50 flaps in 50 patients meeting the inclusion criteria. The senior author has performed nine reverse SUPBRA flaps from 2006 to 2015. The flap was found to be most useful for defects of the thumb, index, palm and first webspace. Variations in vascular anatomy may necessitate a change of operative strategy. Venous congestion was common but transient in the majority. Complications were rare and included minor tip necrosis, scar contracture, donor site sensitivity and numbness, thumb adduction contracture and cold intolerance. CONCLUSIONS: The reverse SUPBRA flap is a versatile flap for reconstructing defects of the thumb, index, palm and first webspace. It is quick to raise, has a low donor site morbidity and complication rate and achieves very reasonable functional and aesthetic outcomes.