A comparative anatomical study of brachioradialis and flexor carpi ulnaris muscles: implications for total tongue reconstruction.
BACKGROUND
Total or subtotal glossectomy following resection of intraoral tumors causes significant morbidity. Recent surgical endeavors have focused on the creation of a neotongue with both sensory and motor innervation. Although various local or regional free flaps have been used for this purpose, the optimal donor site remains undecided. The authors compared the neurovascular anatomy of the brachioradialis and flexor carpi ulnaris to assess their suitability as donor muscles together with overlying skin for functional total or subtotal tongue reconstruction.


METHODS
Eighty-eight brachioradialis and 80 flexor carpi ulnaris muscles were studied, comprising 120 dissected specimens, 18 arterial studies, two venous studies, 20 histologic studies, and eight neurovascular studies.


RESULTS
The dominant vascular pattern of the brachioradialis varied. The major pedicle arose from the radial (38 percent), radial recurrent (42 percent), and brachial arteries (20 percent). The muscle also lacked a single neurovascular pedicle. The vasculature of the flexor carpi ulnaris was consistent. The ulnar artery supplied the dominant pedicle in 86 percent of cases. The entry point of motor innervation is near that of the vascular pedicles. A minor distal nerve accompanied the main vascular pedicle in 65 percent of cases. The overlying skin was supplied by musculocutaneous perforators. The lower lateral cutaneous nerve of the arm supplied the skin over the brachioradialis, and the medial cutaneous nerves of the arm and forearm provided sensation over the flexor carpi ulnaris.


CONCLUSIONS
The authors delineated the anatomical advantages of the flexor carpi ulnaris over the brachioradialis for total or subtotal tongue reconstruction.
Shen
Sarah
S
Melbourne, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Royal Melbourne Hospital, Department of Anatomy and Cell Biology, University of Melbourne.
Pang
Jack
J
Seneviratne
Sugitha
S
Ashton
Mark W
MW
Corlett
Russell J
RJ
Taylor
G Ian
GI
D005542:Forearm; D005927:Glossectomy; D006801:Humans; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000098:blood supply / Q000294:innervation; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation; D014059:Tongue / Q000601:surgery*