Distally based radial forearm flap with preservation of the radial artery: Anatomic, experimental, and clinical studies

Abstract

In this article we report on the anatomical, experimental, and clinical investigations of the distally adipofascial pedicled radial forearm flap based on the small perforators around the radial styloid process. There are about 10 small perforators (0.3-0.5 mm in diameter) from the distal radial artery around the radial styloid process. The longitudinal chain-linked vascular plexuses (suprafascial, paraneural, and perivenous) formed by the forearm ascending and descending branches of septofasciocutaneous perforators meet and cross over with the transverse carpal vascular plexuses around the radial styloid region. Based on these directional-oriented plexuses, distally based adipofascial pedicled radial forearm fasciocutaneous and adipofascial flaps were designed and successfully applied in 34 clinical cases. The pivot point was located at 1-2 cm above the radial styloid. The skin island plus adipofascial pedicle measured between 9-18 cm in length, with the adipofascial pedicle 3-4 cm in width. The length-to-width ratio is 3-5:1. The venous drainage of this distally based flap was investigated anatomically and experimentally. The cephalic vein has no positive role for venous drainage in distally based flaps. The difference between distally based flaps and reverse-flow flaps, clinical selection of fasciocutaneous and adipofascial flaps, advantages and disadvantages, and technical tips for operative success are discussed.

Microsurgical nonmicrovascular flaps in forearm and hand reconstruction

“…It is accepted that these perforator arteries, after perforating the deep fascia, end in the subcutaneous tissue and form a rich vascular network with longitudinal axis, and with branches which realize transversal anastomoses between different source arteries. 11,13,14,18,29,32,43,44 Because the fascial vessels does not seem to contribute always to the skin perfusion, 34,45 the main source of the blood supply for the skin remains the subcutaneous arterial network. 11,13,18,43 Each arterial perforator is accompanied by one or two venae comitantes with a lot of communicating branches between them; they realize a very rich venous plexus which drains both into the superficial and deep systems of veins.…”

“…Generally, it is accepted that, in the extremities, the dominant blood supply is through the direct cutaneous vessels, which are to be considered synonymous with the septocutaneous vessels. 27 From the radial artery [11][12][13][14][15][16]26,[28][29][30][31]32 emerge three types of perforating vessels ( Fig. 2): (1) the inferior cubital artery, described by Lamberty and Cormack, 33 the largest RA perforator, which ensures the blood supply of a larger territory than any other single perforator, extending 10 cm distally from the apex of the antecubital fossa; (2) a few, but larger perforators, both muscular and septocutaneous, emerge in the proximal 2/3 of the forearm; their branches run and anastomose longitudinally; (3) more numerous, but smaller septocutaneous perforators emerge in the distal third of the forearm; their branches run and anastomose transversely.…”

“…3,27 The perforators end in the subcutaneous tissue by forming a very rich network of arterial perfusion with longitudinal axiality and with branches which realize transversal anastomoses between different source arteries. 11,13,14,18,29,32,43,44 This arrangement allows the harvest of local transposition flaps or regional pedicled flaps. 3,27 Generally, because this longitudinal axiality, it is accepted that the pedicled flaps is better to be harvested with their long axis corresponding to the source artery.…”

Symbrachydactyly

“…flaps, and more complex advancement techniques 6,8,[10][11][12]17,21,65 ( Figure 6). Release of the first web space in symbrachydactyly can be more challenging than similar releases done for other diagnoses due to a lack of local skin available.…”

Distal radial and ulnar arteries perforator‐based adipofascial flaps for covering hand traumatic defects

“…We used some of the 10 small perforators (0.3-0.5 mm in diameter) from the distal radial artery around the radial-styloid process. The longitudinal chain-linked vascular plexuses 11 (suprafascial, paraneural, and perivenous) formed by the forearm ascending and descending branches of septofasciocutaneous perforators meet and cross over with the transverse carpal vascular plexuses around the radial-styloid region. On the basis of these directional-oriented plexuses, distally based adipofascial pedicled radial forearm fasciocutaneous and adipofascial flaps were designed and successfully applied in our patients.…”