Cutaneous Vasculature of the Forearm

Abstract

Five fresh human cadavers were injected with lead oxide, gelatin, and water. Nine forearms were dissected and an overall map of the cutaneous vasculature by source vessel was constructed. The average number of arterial perforators per source vessel was calculated. The forearm was then divided into three regions, and the density of perforators per region was calculated and compared. The overall number of arterial perforators decreases from proximal to distal in the forearm, but the overall density of perforators 0.5 mm or larger remains uniform. It was observed that the distal third of the forearm has a rich supply of smaller caliber arterial perforators compared with the proximal two-thirds of the forearm. The angiographic studies demonstrate a series of arterial perforators arising from the radial and ulnar arteries. The perforators in turn are linked longitudinally with other perforators from the same source vessel and transversely with the other major vessel. An understanding of this pattern of arterial supply of the forearm integument is helpful for the design of pedicled skin flaps and perforator flaps in the forearm.

Microsurgical nonmicrovascular flaps in forearm and hand reconstruction

“…More, the use of such flaps as the most recently described perforator flaps seems to represent a major advantage, especially because they avoid the sacrifice of a main artery. 49 The use of this type of flaps in the forearm became possible and broadened their application area after some comprehensive experimental studies regarding the skin vascular pattern in the upper limb 11,29,[31][32][33]34,36 and the study of angiosomes. 28,30,31,45 The harvesting of this kind of flaps needs a very minute dissection, better under magnification, but does not need microvascular sutures; that is why we named these flaps microsurgical nonmicrovascular flaps.…”

“…32,36 The anterior interosseous artery (AIOA) 28,30,37,38 blood supplies the skin over the lateral border of the forearm (over the lower part of extensor pollicis brevis and abductor pollicis longus) through three perforating branches, the most important of them being one that emerges at the proximal border of the pronator quadratus muscle and supplies the extensor muscles of the thumb and the skin over the distal 2/3 of the dorsal aspect of the forearm. 39 The posterior interosseous artery (PIOA) 28,30,36,40,41 gives two groups of fasciocutaneous perforators ( Fig. 5): (1) the first group in the proximal part, which blood supplies the skin between flexor carpi ulnaris and extensor carpi ulnaris muscles; (2) the second group is given off in the lower 2/3, between extensor carpi ulnaris and extensor digiti minimi proprius; their branches fan out in all directions.…”

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications

“…Past studies have identified that the diameter of perforating vessels decreases as the radial artery diminishes in calibre. 11,24 The average diameter and length from origin both decreased with distal location in this study. These results demonstrate that there are many small, short perforators supplying the skin where the distal skin paddle extension is planned according to this suggested modification.…”

Relation between blood flow and tissue blood oxygenation in human fingertip skin

“…The discrepancy between BF and THb is interpreted as the different BF velocities among these sites, with a higher velocity at the fingertip than in other areas. Such high velocities are thought to reflect the presence of more arterial vessels in the fingertip than in the forearm (Kanellakos et al, 2003). Accordingly, BF velocity was higher at the fingertip than in the other areas.…”

“…The high BF and StO 2 levels at fingertip can be explained anatomically. There are more integrated arterial blood vessels that contain abundant OxyHb in the fingertip than in the forearm (Kanellakos et al, 2003). In addition, the dense distribution of AVAs in fingertip skin may be involved in the high StO 2 levels.…”