The Radial Artery Perforator—based Adipofascial Flap for Dorsal Hand Coverage

Microsurgical nonmicrovascular flaps in forearm and hand reconstruction

“…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.…”

“…In its distal third, the RA gives some dorsal branches, one of them-the dorsal superficial branch-running posteriorly under or over the brachioradialis tendon and penetrating through it and the abductor policis longus tendon to supply the skin over the lateral and posterior aspects of the forearm. 12 The territory of the RA extends between the projection of the palmaris longus on the anterior aspect and the projection of the lateral edge of extensor digitorum communis on the posterior aspect. A small area in this territory, over the lower part of extensor pollicis brevis and abductor pollicis longus, is not blood supplied by the radial artery, but by the anterior interosseous artery.…”

“…3 Because the blood supply of those flaps is ensured by musculocutaneous or fasciocutaneous perforator vessels, flaps' harvesting generate a lower donor site morbidity (do not sacrifice the main arteries, or some muscles). Until nowadays, it was described and used all over the body as an important number of free perforator flaps, 1,[4][5][6][7][8][9][10] but only in the last time the local perforator flaps were used in clinical practice [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] ; or, it is well known that, in obtaining a liking with like reconstruction, the use of local resources is the first choice. Because these local flaps need a microsurgical dissection, but do not need microvascular sutures, they could be defined as ''microsurgical nonmicrovascular 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. [11][12][13]16,26,43 The transposition flaps could also be centered by the source artery, but because the transversal arrangement of the perforators in the distal third of the source artery's path, the placement of skin paddles could be lateral or medial, as long as the fascial network remains intact. 34,35 If for pedicled flaps the identification of perforators is not mandatory, for a transposition flap is very important to skeletonize the perforator through a very minute dissection, to improve the rotational arch of the flap.…”

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

“…The anatomic study by Rambe and Pho 27 in 1995 showed a similar result. Also, in 1995, Koshima et al 28 introduced a distally based adipofascial flap for coverage dorsal hand defects. This flap is supplied by a lateral intertendinous perforator of the radial artery located 10 cm proximal to the radial-styloid process.…”