Distally based radial forearm flap with preservation of the radial artery: anatomic, experimental, and clinical studies.
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.
Chang
Shi-Min
SM
Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Hou
Chun-Lin
CL
Zhang
Feng
F
Lineaweaver
William C
WC
Chen
Zhong-Wei
ZW
Gu
Yu-Dong
YD
D000328:Adult; D000818:Animals; D004285:Dogs; D005260:Female; D005542:Forearm; D006225:Hand / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D017534:Radial Artery; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*