Does the Use of the Allen Test is an Absolute Myth?-A Novel Look at the Preoperative Evaluation of the Routine Procedure Before Harvesting Radial Forearm Free Flap.

Radial forearm free flap (RFFF) is one of the most popular free flaps in the history of reconstructive microsurgery. Due to its characteristics, it has found its main application in reconstructions in the head and neck region. Before harvesting this flap due to the removal of 1 of the 2 major forearm arteries, an Allen test has historically been recommended. However, is it necessary to use this test in every patient? During the period of 2013 to 2023, 237 RFFF reconstructions were performed on 220 patients. Each surgeon performing a given procedure received a questionnaire to complete, which concentrated on only 2 questions, each had 2 possible answers. The first, whether the Allen test was performed before harvesting the radial forearm free flap, and second, if there was, whether it ever resulted in the change of the approach to reconstruction. In a whole analyzed group of 237 harvested flaps, there were no acute or chronic ischemic complications regarding the hand itself. Three surgeons who performed the RFFF most frequently stated that they had never done Allen test during the last decade. The remaining number of operators have assured that they always have used Allen test, but the result has never forced them to change the approach. Our study shows that the Allen test has limited utility in patients where the radial forearm flap was harvested from a previously intact donor site.