Aberrant Branch of the Radial Artery Encountered During Elevation of the Radial Forearm Free Flap

Abstract

Although the radial arterial system is fairly consistent in structure, rare anomalies have been encountered. During the elevation of a radial forearm free flap for floor of mouth reconstruction, the authors have encountered an accessory branch of the radial artery arising from the main radial artery at the level of the mid forearm, extending laterally over the brachioradialis muscle, and descending into the dorsal wrist in the subcutaneous plane. This artery, named as the superficial radial artery, is a very rare vascular anomaly of the radial arterial system in the forearm. The reconstructive surgery literature is relatively silent about this particular variant. Knowledge of possible anatomic anomalies and careful identification of vessels are important to prevent damage to the arterial system and enable optimal flap harvest.

Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice

“…Bell et al [41] described in 2011 the superficial ulnar artery as a contraindication to RFFF. Acaturk et al [42] described an accessory branch or the radial artery coursing superficially, naming it the superficial radial artery. Radial artery duplication is another well documented anomaly; Li et al [43] documented duplication in 0.1% of 1400 coronary angiography patients sampled via ultrasound.…”

Anomalous Medial Branch of Radial Artery: A Rare Variant

“…Commonly encountered anomalies of RA include variation in its coursesuperficial or a deeply placed, variable origin, duplication or complete absence of the vessel or its septocutaneous perforator branches (13,16,19). There are very few reports of anomalous branches arising from RA .These anomalous branches described in literature are laterally places and have a superficial course (1,15,22). The only described medial branch was by Bhatt et al (2009) which arose from the RA 1.5cms distal to its origin; however this vessel remained superficial to the FCR supplying the skin and fascia of the distal third of the forearm.…”

Erfolgreiche freie mikrovaskuläre A. radialis-Lappenplastik zur Phalluskonstruktion bei persistierender A. mediana (PMA)

“…Z. B. kann nach Acarturk und Newton ein weiterer Zweig der A. radialis auftreten, der sich als oberflächliche Radialisarterie in der Mitte des medialen Unterarms ausbildet und bei der Präparation entsprechend berücksichtigt werden muss [51,52]. Bhatt et al (2009) beschreiben eine Verzweigung der A. radialis in ihre medialen und lateralen Äste ca.…”

“…Auch eine hohe Abzweigung der A. radialis mit einer Inzidenz von bis zu 18,8 % führt ebenfalls zu veränderten Lagebeziehungen [53]. Die normale anatomische Variante, in der die A. ulnaris und die A. radialis aus der Bifurkation der A. brachialis hervorgehen, liegt nach Acarturk und Newton nur in 70 % aller Fälle vor [51]. Für die A. ulnaris ist nach Thoma und Young zu beachten, dass eine oberflächliche Lage in ca.…”