Elsevier

The Journal of Hand Surgery

Volume 27, Issue 6, November 2002, Pages 1081-1086
The Journal of Hand Surgery

Original Communications
The distally based radial artery/flexor carpi radialis muscle flap for dorsal hand reconstruction: A clinical and cadaver study*,**

Presented at The American Society for Reconstructive Microsurgery Meeting, Cancun, Mexico, January 12, 2002.
https://doi.org/10.1053/jhsu.2002.35869Get rights and content

Abstract

Complex soft tissue defects of the hand often require vascularized tissue for protection and coverage of exposed underlying structures. Pedicled local flaps from the forearm are one reconstructive option, but its use is limited by relatively high donor-site problems, including a disagreeable forearm scar and potential division of superficial forearm nerves. We describe a pedicled local flap option—the distally based radial artery/flexor carpi radialis flap, which potentially decreases forearm donor-site morbidity while still providing for coverage of small hand soft tissue defects. Six cadaver forearm dissections were performed to confirm that the vascular supply to the middle and distal portion of the flexor carpi radialis comes off the radial artery. Four clinical cases are presented in which the flexor carpi radialis muscle based on the distal radial artery was used to cover complex wounds of the dorsum of the hand. We believe the lack of damage to the superficial sensory forearm nerves and the ease of flexor carpi radialis muscle flap elevation make this a versatile flap for small, complex, soft tissue defects of the hand. (J Hand Surg 2002;27A:1081–1086. Copyright © 2002 by the American Society for Surgery of the Hand.)

Section snippets

Anatomic study

Six cadaver forearms were dissected to confirm the neurovascular supply to the FCR muscle. Each extremity was amputated at the shoulder. A longitudinal incision over the volar forearm was used to expose the FCR muscle. Dissection entailed isolation of the muscle's origin and insertion, and its extramuscular nerve branches and vascular supply.

Clinical study

Retrospective chart reviews were performed for 4 clinical cases in which the reversed FCR muscle flap was used to cover complex dorsal hand defects.

Anatomic study

The dissected cadaver muscle areas averaged 44.2 ± 9.2 cm2, composed of an average width of 3.0 ± 0.5 cm and length of 14.7 ± 0.5 cm. The brachial artery served as the only blood supply to the most proximal aspect of the FCR muscle in all cases. This first large vascular branch off the brachial artery entered the muscle on average 2.4 ± 1.4 cm distal to the medial epicondyle. An additional smaller branch off the anterior interosseus artery entering the proximal third of the muscle belly was

Discussion

This study describes the use of the FCR muscle pedicled on the reverse radial artery as a muscle flap for complex defects of the hand. The cadaver dissections undertaken in 6 arms confirm the blood supply to the middle and distal third of the FCR as originating exclusively off the radial artery. This is consistent with previous reports in the literature.11 In all 4 clinical cases, after harvesting the FCR and detaching it from its proximal blood supply off the brachial artery, the proximal

References (19)

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*

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

**

Reprint requests: Gregory Dumanian, MD, Division of Plastic and Reconstructive Surgery, Northwestern University Medical School, 675 N Saint Clair St, Suite 19-250, Chicago, IL 60611.

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Copyright © 2002 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.