An Anatomy Study And Clinical Application Of The Forearm Radial Artery Perfectors Flap

OBJECTIVE Through investigated the anatomy of cutaneous perfectors of the forearm radial artery,to underline the anatomic basis for the design and use of the forearm radial artery perfectors flap in hands, In order to recommend a technique for repairing the soft tissue defect in hands and reconstrueting the function of the first web space.and report its primary clinical application.METHODS①eighteen upper limb adult cadavers were used for this anatomic study.Each cadaver was injected with a mixture of red gelatin (nature rubber with red paint) with manual pressure through the intra-arteries.After injection,we concentrated our dissection of 1/3 inferior segment of forearm with the assistance of a magnification loupe (x5). Our focus is to dissect and observe the major arteries on the forearm,their anastomoses, nutritional vascular axis that accompany the perfectors and the radial artery and measure their length and exterior diameter.②From Jun,2008 to Jan,2010,five flaps were harvested to repair the soft tissue defect in hands and reconstrueting the function of the first web space, administered medicine:Huo Xue ZHI TONG Tang to all patients.RESULTS there were cutaneous perfectors approximately 14 branches from the forearm radial artery, near side section number were few (average 3), but the caliber was big, the distalis section number were many (average 11),but the caliber was small, the radial artery both sides sent out perfectors branches with diameter (0.7±0.4) mm, and to send out the branches longitudinal vascular networts mutually along the vertical good direction. The origins of cutaneous perfectors of the forearm radial artery were as follows:①DorsaI carpal shallow branch of the radial artery:After passing through the brachium oar tendon,dropt in its flank, the dorsal carpal shallow branch of the radial artery was (7.0±1.1)cm away from radius styloid process and the starting external diameter was (0.6±0.3)mm,and Divided into thin short rose and thick long fallen;②Cutaneous branches of superficial palmar branch:The radial artery sent out Cutaneous branches of superficial palmar branch in forearm lower segment near wrist, Cutaneous branches of superficial palmar branch was(1.5±1.0)cm away from radius styloid process and the starting external diameter was (1.5±0.2)mm, length (2.3±1.0)cm;③Malleolus radialis recurrent branch cutaneous branches:In the Tabatiere anatomique nest area, the radial artery or dorsal carpal branch of radial artery near-end sent malleolus radialis recurrent branch cutaneous branches(1～2),malleolus radialis recurrent branch cutaneous branches was superior of radius styloid process about (0.5±0.3)cm with length (1.0±0.5)cm and the starting external diameter of (0.8±0.1) mm.Malleolus radialis recurrent branch cutaneous branches included periosteum branches,fascia branches and cephalic vein nutrient vessels, the starting external diameter was (0.5±0.2) mm;④Tabatiere anatomique cutaneous branches:Radial artery from styloid process of radius far-end suddenly diagonal outside, line of the thumb exhibition tendon and thumb extends the tendon short the deep surface.In Tabatiere anatomique nest of radial artery near section,Or carpal dorsal branch of radial artery near-end sent out 1～2 branches.Tabatiere anatomique cutaneous branches was(1.2±0.3)cm away from radius styloid process and the starting external diameter was (0.6±0.1)mm.⑤Osteal cutaneous branches of spatium intermusculare of radial artery:the intermuscular spaces perforating branches of radial artery being superior of radius styloid process about 8.0～16.0cm (1～3 branches) with the starting external diameter of(1.2±0.2)mm .Among five patients receiving reconstruction for repairing the soft tissue defect in hands and reconstrueting the function of the first web space with the forearm radial artery perfectors flap,we administered medicine:Huo Xue ZHI TONG Tang to all patients,the flap of case 2 and 4 was congested and developed tension blisters, which was proved to be very effective for both flaps better survived.Case 2 was slightly dark 3 days after the operation and developed flap necrosis about the size of 2cm×2cm,which healed with dressing change.Other cases healed uneventfully. The texture of flaps were good,the outline and functional results were satisfactory.CONCLUSION The cutaneous branches had multi-sources blood supply in the 1/3 inferior segment of forearm.there are longitudinal vascular networts interweaved inside and around the forearm radial artery.These nutritional vessels give off branches to the skin around the nerve.the forearm radial artery perfectors flap was designed to repair the soft tissue defect in hands and reconstruet the function of the first web space.the forearm radial artery perfectors flap has advantages as follows:reliable blood supply,smiliar texture and thinness to the skin of hand,adjacent transfer,flap survival rate highly,short operative duration,minimal intra-operative blood loss.So the forearm radial artery perfectors flap is one of the perferable regions to repair the soft tissue defect in hands and reconstruet the function of the first web space.