An anatomic study of the dorsal forearm perforator flaps (original) (raw)
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A New Perforator Flap From Distal Medial Arm: A Cadaveric Study
Eplasty, 2010
Background: In this study, a new fasciocutaneous perforator flap raised from inner medial surface of the distal medial arm has been described for soft tissue coverage. Methods: The blood supply of this flap comes directly from the distal brachial artery. Fourteen limbs of 7 formalinized cadavers were dissected to study the origin and the course of perforator vessel. Results: The average size of the flap was 10.7 cm × 5.6 cm in the distal medial arm region. The constant main perforator was measured within a circle of 2.76-cm diameter, the center of which was 11.5 cm above and 1.3 cm medial to the medial epicondyle of humerus. The mean length and diameter of the distal brachial perforator artery were 3.3 cm and 0.95 mm, respectively. Conclusion: We think that this flap may be a useful option for the reconstruction of soft tissue defect of elbow.
Anterior Interosseous Artery Perforator Flap for Distal Forearm and Hand Defects
IOSR Journals , 2019
Anterior inter osseous artery perforator flap is a versatile and reliable flap in covering volar aspect of distal forearm, dorsal surface of hand that are classical defects following electrocution and snake bite cellulitis sequel. Our experience with 5 cases done between 2017 t0 2018 as transposition flap and island flap for defects following electrocution, infection and following trauma, was shared. No prior Doppler study was done to locate the perforator in any case. Perforator was present in all the cases. The planning, ease of dissection, surgical technique, reach of the flap and reliability has been discussed. All the flaps survived well.
Anatomical study of perforator arteries in the distally based radial forearm fasciosubcutaneous flap
Clinical Anatomy, 2004
We investigated the anatomical vascular basis of the forearm fasciosubcutaneous flap (FSC-F), fed by the distal perforator arteries of the fascia. This type of flap was proposed, in hand reconstructive surgery, to avoid the disadvantages caused by axial-pattern reverse radial forearm fasciocutaneous flap, based on ligation and rotation of the radial artery (RA). In eight fresh cadaveric forearms, the RA was injected slowly with acrylic resin and the superficial flexor compartment was dissected. Then the FSC-F was raised from the lateral margins of the sample to the median RA axis, and the collaterals of the RA (number, interval of origin, and caliber) were evaluated. The fascial branches of RA (mean number Ϯ SD: 20 Ϯ 3) originated mainly from the radial and ulnar sides of the RA. In the distal forearm the vessels were more numerous (mean value ϭ 11.3 vs. 8.9; Student's t-test, P Ͻ 0.05) but smaller in diameter (mean value ϭ 0.45 mm vs. 0.63 mm; Student's t-test, P Ͻ 0.05). The perforator arteries forked in a T-shape following the main axis of the forearm and anastomosed in the fascial plane, forming longitudinal fan-shaped arterial chains giving rise to the vascular epifascial network. Histological (hematoxylin-eosin, azan-Mallory, Weigert) and immunohistochemical (anti-von Willebrand factor) study of the FSC-F at different levels of sampling was also carried out. The epifascial branches of distal sections were smaller in diameter (78.3 Ϯ 35.5 m) than those of intermediate (105.7 Ϯ 28.7 m; Newman-Keuls test, P Ͻ 0.01) and proximal (116.8 Ϯ 31.2 m; Newman-Keuls test, P Ͻ 0.001) sections. Our findings indicate that the perforator arteries and epifascial branches are smaller in the distal forearm, so that during surgical dissection, the safety distance from the radial styloid should take into account that also in the presence of a sufficient number of vessels in the distal forearm their caliber could be inadequate to the hemodynamic request of the flap. Thus, rather than on a theoretic distance from the radial styloid, the length of the flap should be based on an accurate evaluation of the individual vascularization of the forearm case by case. Clin. Anat. 17: 636 -642, 2004.
Reconstruction of Forearm, Wrist and Hand Skin Defects with Local Perforator Flaps
Ain Shams Medical Journal, 2019
Background: During the last decades, anatomical studies on skin vascularization provided the base for the development of flaps nourished by perforating arteries and preserving major vessels. In the last years, perforator flaps have become an appealing option for coverage of a large range of defects as they allow for great freedom in design and for reconstruction of difficult wounds with minimal donor-site morbidity, but doubts regarding their reliability have overshadowed its safety in clinical practice. Aim of the Work: This prospective clinical study is conducted to assess the reliability and efficacy of local perforator flaps in coverage of hand, wrist, and forearm skin defects. Patients and methods: We conducted a prospective study involving 20 patients with hand, wrist, and forearm skin defects and were covered with local radial and ulnar arteries perforator flaps. Postoperative complications were recorded and assessment of patients' satisfaction as regards donor site morbidity and aesthetic outcome of the flap was done by a questionnaire at the outpatient clinic and the results were classified as unsatisfactory, satisfactory, good, and very good. Vancouver Scar Scale was applied as an objective tool for scar assessment postoperative. Three-month follow up was the end point of this study. Results: Radial artery perforator flaps were done in 11 cases (55 %) and ulnar artery perforator flaps in 9 cases (45%).Temporary venous congestion happened in 19 cases, distal tip necrosis in 10 cases, superficial epidermolysis in 8 cases, and arterial insufficiency in one case. Mean operative time was 63.8 min., 70.64 min. in RA perforator flaps and 55.44 min. in UA perforator flaps. Conclusion: Perforator flaps are a reliable tool for upper extremity coverage, with a low rate of failure and secondary surgery. These flaps are particularly useful for covering small and medium sized defects in the distal one third of the forearm, wrist, and hand; and they represent a reliable and effective alternative to free flaps.
Vascular analysis of radial artery perforator flaps
Annals of Maxillofacial Surgery, 2018
Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction in head & neck. Although there are several advantages, it requires the sacrifice of a major artery of forearm. There are several modifications of harvesting a forearm flap based on perforator principles. A clear understanding of vascular anatomy of individual perforators relative to its vascular territory & flow characteristics is essential for both flap harvest & design. The purpose of this cadaveric observational anatomical study was to determine the location, size & vascular territory of the radial artery cutaneous perforators. Materials and Methods: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the total number, location, size & vascular territory of radial artery adipo-fascio cutaneous perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram. Results: In the 12 fresh human cadavers & 24 forearm specimens, a total of 222 perforators were dissected for an average of 18.5 radial artery perforators per forearm. Of the total 222 perforators dissected 118 were smaller than 0.5mm in diameter (53.15%) these were not clinically significant. 104 perforators were greater than 0.5mm in diameter (46.84%) these were clinically significant. Of the 222 radial artery perforators dissected, 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. A total of 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators on radial side was 10.6 & 7.9 on ulnar side, a comparison of both using student t paired test gives a P value of 0.006, which was statistically significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0, Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean Diameter of perforators between the Distal side (1.11) & Proximal side (0.86) using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which were more than 1mm (80%) & less than 1mm (20%) & on proximal side more than 1mm (35.6%) & less than 1mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1& P value of <0.001 was achieved which was found to be highly significant. Methylene blue injections into the proximal part of radial artery demonstrated clusters both in proximal & distal forearm & also cutaneous territory of flap. Three-dimensional computed tomographic angiography reveals a network of linking vessels found to communicate between adjacent perforators & running parallel to radial artery. Large network of linking vessels could be found between fascia & dermis, which also explains the ability to harvest forearm flap at the supra-fascial level. Conclusion: Increase in knowledge of vascular territory of radial artery perforators with regards to numbers, size, location, and cutaneous territory can lead to expanded use of radial forearm flap based on either distal or proximal perforator alone, without sacrificing the radial artery.
Microsurgery, 2008
The use of perforator flaps all over the body, as free microsurgical transfers, as well as pedicled or transposition flaps gained more and more importance in the surgery of tissue defects. When we consider harvesting such flaps at trunk level, in repeatedly traumatized areas, after previous surgery or when we plan to use the perforator flap as a free flap, it is very important to perform preoperative investigations aimed to precisely localize the perforator or perforators able to sustain such a flap. But, at limb level and, especially, at forearm level, the preoperative investigations cannot always have a complete justification. After a short review of the main preoperative investigations used in flap surgery and considering our color Doppler study, we will present in this article our technique of performing such flaps in the forearm, without any preoperative perforator vessel detection. V V C 2008 Wiley-Liss, Inc. Microsurgery 28:321-330, 2008.
The posterolateral mid-forearm perforator flap: Anatomical study and clinical application
Microsurgery, 2013
Background: Defects sustained at the distal forearm are common and pedicled perforator flaps have unique advantages in resurfacing it. The purpose of this study is to reappraise the anatomy of the perforator in the posterolateral aspect of the mid-forearm and present our clinical experience on using perforator flaps based on it for reconstruction of defects in the distal forearm. Methods: This study was divided into anatomical study and clinical application. In the anatomical study, 30 preserved upper limbs were used. Clinically, 11 patients with defects at the forearm underwent reconstruction with the posterolateral mid-forearm perforator flaps. The defects, ranging from 4.5 3 2.5 cm to 10.5 3 4.5 cm, were located at the dorsal aspect of the distal forearm in 6 cases and at the volar aspect of the distal forearm in 5 cases. Results: Three patterns of the perforator were observed in the posterolateral aspect of the mid-forearm, which originated from the posterior interosseous artery, the proximal segment of the radial artery or the radial recurrent artery, and the middle segment of the radial artery, respectively. The perforator was located 11.8 6 0.2 cm to 15.8 6 0.4 cm inferior to the lateral humeral epicondyle. Clinically, flaps in 8 cases survived uneventfully, while the other 3 cases suffered mild marginal epidermal necrosis, which was cured with continuous dress changing. Conclusion: The location of the perforator at the posterolateral aspect of the mid-forearm is consistent; the posterolateral mid-forearm perforator flap is particularly suitable to cover defects in the distal one-third of the forearm.
International Journal of Otolaryngology and Head & Neck Surgery, 2018
Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.