The Radial Artery Pedicle Perforator Flap:  Vascular Analysis and Clinical Implications.
BACKGROUND
The purpose of this study was to determine the location, size, and vascular territory of the radial artery cutaneous perforators.


METHODS
Twenty-six human cadaveric forearms were dissected. All cutaneous radial artery perforators were analyzed for total number, orientation, location, and external diameter. A cluster analysis was performed to determine the overall distribution of perforators. The cutaneous territory of a distally based pedicled perforator flap was determined using methylene blue injection and three-dimensional computed tomographic angiography in five flaps.


RESULTS
Six hundred thirty-nine perforators (399 perforators smaller than 0.5 mm compared with 240 perforators 0.5 mm or larger) were dissected in 26 forearms. Of the 639 radial artery perforators dissected, 328 (51 percent) were radially distributed and 311 (49 percent) were ulnarly distributed. There are two main clusters of clinically relevant perforators at a relative distance of 17.6 percent and 61.7 percent along the radial styloid-to-lateral epicondyle interval. In all cases, two or more perforators were found within 2 cm proximal to the styloid. Dye injection of the most dominant distally based perforators revealed a cutaneous territory ranging from 104 cm2 to 333 cm2. The case presented is of a patient with a dorsal hand defect, which was resurfaced with a pedicled perforator flap based on a distal perforator proximal to the radial styloid.


CONCLUSIONS
There are two main clusters of clinically significant radial artery perforators. Increased knowledge of size, location, and cutaneous territory of the radial artery perforators can lead to expanded use of the radial artery forearmflap based on cutaneous perforators alone, without sacrificing the radial artery.
Saint-Cyr
Michel
M
Dallas, Texas; and Louisville, Ky. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and the Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine.
Mujadzic
Mirsad
M
Wong
Corrine
C
Hatef
Dan
D
Lajoie
Andrew S
AS
Rohrich
Rod J
RJ
D002102:Cadaver; D004396:Coloring Agents; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008297:Male; D008751:Methylene Blue; D017534:Radial Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D004396:Coloring Agents; D008751:Methylene Blue