The pronator quadrates muscle flap

doi:10.1016/S0363-5023(84)80236-1

The Journal of Hand Surgery

Volume 9, Issue 3, May 1984, Pages 423-427

https://doi.org/10.1016/S0363-5023(84)80236-1 Get rights and content

Traumatic injuries to the distal forearm present a challenging problem for soft tissue coverage. There is a need for a local flap to provide a vascularized soft tissue bed. This article demonstrates the anatomic basis that enables the pronator quadratus muscle potentially to fulfill these needs.

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There are more references available in the full text version of this article.

Cited by (103)

Optimizing Outcomes in Revision Peripheral Nerve Surgery of the Upper Extremity
2024, Clinics in Plastic Surgery
Recalcitrant Neuropathies in the Upper Extremity
2023, Journal of Hand Surgery Global Online
Carpal and cubital tunnel syndrome can cause debilitating pain and weakness in the hand and upper extremities. Although most patients have a resolution of their symptoms after primary decompression, managing those with recalcitrant neuropathies is challenging. The etiology of persistent, recurrent, or new symptoms is not always clear and requires careful attention to the history and physical examination to confirm the diagnosis or consider other causes prior to committing to surgery. Nevertheless, revision surgery is often needed in the setting of recalcitrant neuropathies in order to improve patients’ symptoms. Revision surgery typically entails wide exposure and neurolysis to release residual compression. In addition, vascularized tissue and nerve wraps have been routinely used to create a favorable perineural environment that decreases recurrent scar formation. This review discusses the etiologies of recalcitrant upper extremity neuropathies, the current treatment options, and surgical outcomes.
Recurrent carpal tunnel syndrome: Outcomes after neurolysis and synovial flap
2023, Hand Surgery and Rehabilitation
If symptoms recur after primary neurolysis of the median nerve, surgical revision is required. Soltani et al. (2013) demonstrated that surgical revision with vascularized flap coverage had a higher success rate (86%) than surgical revision without a flap (75%). The aim of this retrospective study was to present clinical outcomes in 36 cases of secondary open neurolysis of the median nerve, with synovial flap in case of recurrent carpal tunnel syndrome.
Thirty-three patients (36 hands) who had undergone secondary neurolysis of the median nerve combined with synovial flap coverage between 2012 and 2019 were selected for this study. We included only recurrent carpal tunnel syndrome cases presenting with scarring of the transverse carpal ligament or epineural fibrosis of the median nerve and with a symptom-free period of at least 3 months. The results were ranked on a 4-point scale as excellent, good, null or poor, depending on progression at last follow-up.
Descriptive analysis showed that 80% of patients had a positive outcome (excellent 33%, good 47%), 6% null outcome and 14% poor outcome.
This is an interesting, relatively non-invasive surgical option, and should be part of the therapeutic armamentarium for recurrent carpal tunnel syndrome in case of adherence of the nerve to the transverse carpal ligament.
Les révisions chirurgicales après neurolyse primaire du nerf médian sont nécessaires en cas de récidive des symptômes. Soltani et al. (2013) ont démontré que les révisions chirurgicales avec interposition d’un lambeau vascularisé ont un taux de succès supérieur (86 %) aux révisions chirurgicales sans lambeau (75 %). L’objectif de cette étude est de présenter les résultats cliniques d’une série rétrospective incluant 36 neurolyses secondaires du nerf médian à ciel ouvert et lambeau synovial en cas de récidive de syndrome du canal carpien.
Trente-trois patients (36 mains) ayant bénéficié d’une neurolyse secondaire du nerf médian associée à un lambeau synovial entre 2012 et 2019 ont été sélectionnés pour cette étude. Seuls les cas avec récidive de syndrome du canal carpien présentant une cicatrisation du rétinaculum des fléchisseurs ou présentant un nerf médian avec une fibrose épineurale et avec un intervalle libre de symptômes d’au moins trois mois ont été inclus. Les résultats ont été répartis en quatre catégories (excellent, bon, nul, mauvais) en fonction de l’évolution au dernier suivi post-opératoire.
Les analyses descriptives démontrent que 80 % des patients présentent une évolution favorable, dont 33 % un résultat excellent et 47 % un bon résultat, alors que 6 % présentent une évolution nulle et 14 % un mauvais résultat.
Cette option chirurgicale peu invasive est intéressante et devrait faire partie de l’arsenal thérapeutique des récidives de syndrome de canal carpien lors d’adhérence du nerf au ligament transverse du carpe.
Pronator quadratus musculo-osseous free flap for wide hard palatal defect reconstruction: An anatomical study
2023, Journal of Plastic, Reconstructive and Aesthetic Surgery
Wide hard palate defects include congenital and acquired defects that are six square centimeters or larger in size. Obturator prostheses and autologous soft tissue transfers have been used to reconstruct palatal defects. This study aims to repair wide, hard palatal defects by using a pronator quadratus musculo-osseous free flap to achieve subtotal reconstruction. Seventeen formalin-fixed cadavers were dissected. Free musculo-osseous pronator quadratus flaps were prepared after a 12 cm curvilinear volar skin incision. Standard 30 × 23 mm (690 ± 52.12 mm²) hard palate defects were made by chisels and saws. A subcutaneous tunnel was created between the mandibular edge cross point of the facial vessels and the retromolar trigone through the subcutaneous to the superficial musculoaponeurotic system by dissection. Area measurements of the pedicle and palate defects were performed by the ImageJ program (National Institutes of Health, Bethesda, MD, USA) on drawings over an acetate layer of materials. Mandibular distances of gonion-facial vessel cross point (a), gonion-gnathion (m), and facial vessels’ cross point-retromolar entrance point (h) were measured. Ratios of h/m and a/m were calculated. The mean pronator quadratus area was 2349.39 ± 444.05 mm², and the arterial pedicle pronator quadratus diameter was 2.32 ± 0.34 mm. The mean pedicle length of the pronator quadratus was 117.13 ± 8.10 mm. Study results showed that musculo-osseous pronator quadratus flaps’ bone and muscle parts perfectly fit on the defects in all cadavers. Pronator quadratus musculo-osseous flap is a feasible surgical option for wide, hard palatal defect reconstruction strategies.
Use of free radial forearm and pronator quadratus muscle flap: Anatomical study and clinical application
2022, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Therefore, the preservation of the deep head is important.15 Nevertheless, the use of RFF with the PQM does not lead to a complete loss of the pronation of the forearm as this action is, as mentioned above, provided primarily by the pronator teres muscle.16–18 We confirmed the same in our study (supination and pronation mean 87.4/ 85.16°).
The authors present an anatomical study and clinical experience with radial forearm flap (RFF) and pronator quadratus muscle (PQM) application in the reconstruction of various body areas. The aim was to describe the anatomical placement and proportions of the PQM, the anatomical location of the major arterial branch of the radial artery supplying the PQM, and the application of this knowledge in clinical practice.
The anatomical study was based upon an analysis of 13 fresh adult cadaver upper extremities, of which nine were female and four male; both arms from the same donors were used in four cases. The study of the PQM was performed using a dye-containing intraarterial injection, standard macro– and micro–preparation techniques, and chemical digestion. The data on the PQM size in males and females, thickness of the radial artery branch (the principal artery nourishing the muscle), and its position were analysed. The radial artery branch nourishing the PQM was identified in all cadaveric specimens of the anatomical study.
In addition, 12 patients underwent reconstructions of soft and bony tissue defects using a RFF + PQM (pedicled or free flap). The radial artery branch perfusing the PQM was identified in all cases. The flap was used for the management of defects of the head (seven cases), arm (three cases) and lower leg (two cases). The harvest site healed well in all cases and, with the exception of one case in which a partial necrosis of the flap was observed, all flaps remained viable, which demonstrated the safety of the method.
Transfer of the pronator quadratus to restore opposition of the thumb: An anatomic study and a clinical report
2022, Annales de Chirurgie Plastique Esthetique
L’objectif de cette étude est d’étudier la faisabilité de la reconstruction du court abducteur du pouce par un lambeau de carré pronateur pédiculé réinnervé, et de rapporter les résultats dans un cas d’hypoplasie congénitale de pouce bilatérale.
Vingt-et-un membres supérieurs injectés ont été disséqués. Le carré pronateur a été levé a retro sur l’artère transverse du carpe et réinnervé sur la branche motrice du court fléchisseur du V. Le transfert a été évalué sur 3 paramètres : sa faisabilité, la longueur du pédicule et la distance entre le site de coaptation et le nerf receveur. Un transfert pédiculé de carré pronateur bilatéral a été réalisé chez un enfant de 17 mois présentant une hypoplasie congénitale de pouce bilatérale.
Le transfert était réalisable et son extrémité distale atteignait le bord radial de la MCP du pouce dans tous les cas. La longueur du pédicule distal sur l’artère transverse du carpe était de 38,6 ± 0,20 mm. La distance entre le site de coaptation à l’entrée du carré pronateur et la branche du court fléchisseur du V était de 43,4 ± 0,38 mm. À 7 mois postopératoire, on retrouve une amélioration esthétique de l’éminence thénar, une abduction M3 bilatérale du pouce et l’utilisation de la pince pollici-digitale.
Le transfert du carré pronateur pédiculé permet la reconstruction du court abducteur du pouce tant sur le plan fonctionnel qu’esthétique, sans sacrifice fonctionnel associé.
The purpose of this study is to explore the feasibility of reconstructing the APB with a pedicled PQ flap, and to report results in a child presenting with bilateral radial deficiency.
Twenty-one injected cadaver upper extremities were dissected. The muscle was pedicled distally on the transverse carpal artery, and reinnervated with the flexor digiti minimi (FDM) motor branch. The transfer was evaluated on 3 parameters: surgical feasibility, length of the distal pedicle and distance from the coaptation site to the muscle entry of recipient nerve. A bilateral PQ pedicled transfer was accomplished in a 17-month old child with bilateral radial deficiency.
In the cadaver study, transfer of PQ to the APB was feasible and the distal end of the PQ transfer was reaching the radial side of the first metacarpophalangeal joint in all cases. The length of the distal pedicle on the transverse carpal artery was 38.5 ± 0.20 mm. The distance from coaptation of the FDM to the PQ muscle entry was 43.0 ± 3.77 mm. At 7 months, there was a cosmetic improvement of the thenar eminence, a bilateral M3 abduction of the thumb and a functional improvement from bilateral PQ pedicled transfer.
Reconstruction of the APB may be achieved with a PQ pedicled transfer reinnervated, improving the function and the cosmetic aspect of the thenar eminence without sacrificing any function of the hand.

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^*: Present address: Division of Plastic Surgery, Sunnybrook Medical Center, University of Toronto, 2075 Bayview, Toronto, Ontario, Canada.

View full text

The pronator quadrates muscle flap

The management of chronic ulcers of the foot by muscle transposition and free skin grafting

Br J Plast S urg

Clinical atlas of muscle and musculocutaneous flaps

Flap reconstruction in hand surgery: The evolution of presently used methods

J Hand Surg

The groin flap in severe hand injuries

Ann Plast Surg

Implantation of sensory nerve into muscle: Preliminary clinical and experimental observations on neuroma formation

Ann Plast Surg