Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases

Abstract

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes.Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated.Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness.Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

Finger defect reconstruction using the radial artery superficial palmar branch free flap

“…Despite variations in the branching pattern of the RASP vessel [26][27][28], this flap is known for its many advantages. Besides providing a glabrous and color-matched tissue, it can also be sensate [2,[29][30][31][32][33]. In addition, an operation can be done in a single field under a brachial plexus block without sacrificing a major artery.…”

“…In addition, an operation can be done in a single field under a brachial plexus block without sacrificing a major artery. Furthermore, even though there may be variations in the pattern of RASP branching from the radial artery, skin perforators tend to arise consistently adjacent to the scaphoid tubercle [2,[29][30][31][32][33]. The donor site, in most cases, can be primarily closed, and since thenar muscles are spared, thumb function is usually preserved [2,30,32].…”

“…Fingers reconstructed were either single or multiple, ranging from two to four. Previously, many studies have been published to evaluate the usefulness and safety of this particular flap [2,[29][30][31][32][33]. In this paper, the authors revisited the RASP free flap.…”

Full-Thickness Skin Grafts for Coverage of the Pedicle in Partial Second Toe Pulp Free Flap

“…The dimensions of the pedicle are well matched to the digital vessels, and donor site morbidity is negligible [1]. Other options for small volume reconstruction include the great toe pulp free flap, the toe plantar flaps, hypothenar free flap, radial artery superficial palmar branch flap, ulnar artery perforator flap, radial artery perforator flap, dorsoradial artery perforator flap, and dorsoulnar artery perforator flap [2][3][4].Insetting the small free flap is relatively straightforward, as most fingertip defects will require anastomosis to one of the digital arteries. Most of the time however, the small cylindrical geometry of the finger is too snug to allow relaxed coverage of the pedicle.…”

“…The dimensions of the pedicle are well matched to the digital vessels, and donor site morbidity is negligible [1]. Other options for small volume reconstruction include the great toe pulp free flap, the toe plantar flaps, hypothenar free flap, radial artery superficial palmar branch flap, ulnar artery perforator flap, radial artery perforator flap, dorsoradial artery perforator flap, and dorsoulnar artery perforator flap [2][3][4].…”