Anatomic Variation in the Blood Supply of the Radial Forearm Flap

Abstract

The traditional radial forearm flap derives its blood supply from perforators of the radial artery. This report describes an anatomic anomaly in which the flap was supplied solely by perforators of the ulnar artery. Knowledge of this previously undescribed variation might have relevance when a radial forearm flap is raised.

Dealing with aberrant vessels in radial forearm flaps – Report of a case and review of literature

“…All of these reports describe the course of the aberrant vessel as lateral to the usual radial artery. There are no descriptions in the reconstructive and anatomical literature of a superficial and medial branch originating from the radial artery 1.5 cm Weathersby (1956) High origin of radial artery 408 Upper extremities studied revealed departure from normal textbook anatomy in 18.8% of specimens Coleman and Anson (1961) High origin of radial artery 650 Dissected specimens studied Persistent median artery Kadanoff and Balkansky (1966) Duplication of radial artery Case report Small and Millar (1985) Radial artery passing deep to the pronator teres Case report Poteat (1986) Absent radial artery Cadaver dissection single specimen Uglietta and Kadir (1989) High origin of radial artery 100 Upper extremity arteriograms reviewed revealed anomalies of the radial artery in 9% of cases Hedén and Gylbert (1990) Superficial dorsal antebrachial artery Case report Bass (1991) Hypolasia of radial artery Case report e association with VATER syndrome Otsuka and Terauchi (1991) Aberrant dorsal course of radial artery around Lister's tubercle Case report Madaree and McGibbon (1993) Absence of perforators from the radial artery to skin Case report Funk et al (1995) Distal origin of radial artery deep to pronator teres Review of experience with 52 forearm flaps Superficial dorsal antebrachial artery High origin of radial artery Lee et al (1995) Hypoplasia of radial artery Case report e association with KlippeleFeil syndrome Mordick (1995) Aberrant midaxial vessel arising directly from axillary artery Case report Icten et al (1996) High origin of radial artery Case report Sasaki et al (2000) Superficial dorsal antebrachial artery Case report Porter and Mellow (2001) Absent radial artery Case report Rodríguez-Niedenführ et al (2001) High origin of radial (brachioradial) in 20.3% of sample 192 Embalmed cadavers examined. Variable terminology unified into a homogenous classification following extensive review of literature and meta-analysis of results…”

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

“…1 In very rare instances the radial artery demonstrates anomalies. These rare anomalies of the vascular system encountered during the elevation of radial forearm flaps may include the radial artery passing under the pronator teres muscle, 2,3 a high takeoff of the radial artery, 3 no perforator connections between the radial vascular bundle and overlying fascia, 4,5 and complete absence of the ''deep'' radial artery with the superficial radial artery being the only radial system. 6 In addition, complete absence of the radial artery in an otherwise normal person has been described.…”

The Anomalous Radial Artery: A Rare Vascular Variant and Its Implications in Radial Forearm Free Tissue Transfer

“…Madaree and McGibbon discovered a radial artery that did not supply any fasciocutaneous perforators to the forearm. 13 In this case, the ulnar artery was chosen for the flap since it was providing all fasciocutaneous vascularization. Bhatt et al discovered an aberrant vessel supplying the skin paddle, and this vessel was taken in favor of the radial artery to utilize the flap, the intraoperative Allen’s test was utilized in this case to determine which vessel was providing dominant supply to the skin paddle.…”