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    Adial Orearm Lap: Tor Chiu

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    Al
    The radial forearm flap consists of fasciocutaneous tissue from the volar forearm supplied by branches of the radial artery. It is based on septocutaneous perforators between the flexor carpi radialis and brachioradialis muscles, draining through venae comitantes or the cephalic vein. The flap harvest begins with a distal skin incision and subfascial dissection to preserve the paratenon, ligating the distal radial artery to facilitate raising the flap along the axis of the radial artery proximally.

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    Adial Orearm Lap: Tor Chiu

    Uploaded by

    Al
    34 views5 pages
    The radial forearm flap consists of fasciocutaneous tissue from the volar forearm supplied by branches of the radial artery. It is based on septocutaneous perforators between the flexor carpi radialis and brachioradialis muscles, draining through venae comitantes or the cephalic vein. The flap harvest begins with a distal skin incision and subfascial dissection to preserve the paratenon, ligating the distal radial artery to facilitate raising the flap along the axis of the radial artery proximally.

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    flap

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    15_RADIAL-FOREARM-FLAP

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    The radial forearm flap consists of fasciocutaneous tissue from the volar forearm supplied by branches of the radial artery. It is based on septocutaneous perforators between the flexor carpi radialis and brachioradialis muscles, draining through venae comitantes or the cephalic vein. The flap harvest begins with a distal skin incision and subfascial dissection to preserve the paratenon, ligating the distal radial artery to facilitate raising the flap along the axis of the radial artery proximally.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views5 pages

    Adial Orearm Lap: Tor Chiu

    Uploaded by

    Al
    The radial forearm flap consists of fasciocutaneous tissue from the volar forearm supplied by branches of the radial artery. It is based on septocutaneous perforators between the flexor carpi radialis and brachioradialis muscles, draining through venae comitantes or the cephalic vein. The flap harvest begins with a distal skin incision and subfascial dissection to preserve the paratenon, ligating the distal radial artery to facilitate raising the flap along the axis of the radial artery proximally.

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    © All Rights Reserved
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    of 5

    15

    Radial Forearm Flap

    Tor Chiu

    Anterolateral Thigh Flap  139


    Radial Forearm Flap

    FLAP TERRITORY the flexor carpi radialis (FCR) and brachio-


    radialis (BR), with drainage through venae
    This flap consists of fasciocutaneous tissue comitantes (VC) and/or cephalic vein. Over
    from the volar surface of the distal forearm its length there are an average of 9-17
    supplied by branches of the radial artery. skin perforators that tend to be found in
    It is most often designed as a free flap proximal and distal clusters. The diameter
    but may be pedicled e.g. distally for hand of the artery is around 2.5 mm. Figure 1
    defects. The flap can be made ‘sensate’
    by inclusion of either the medial or lateral FLAP HARVEST
    cutaneous nerves of the forearm.
    The patient should be placed in a
    The flap is based on the axis of the radial
    supine position with the arm on a
    artery. For larger flaps, care should be
    board positioned almost perpendicular
    taken to ensure that the ulnar pedicle is not
    to the body. The operation is often
    exposed. Instead the flap should extend
    performed under tourniquet control and
    over the radial border to the dorsum if
    a preoperative Allen’s test should be
    necessary, although this will increase the
    performed.
    sensory deficit.
    The axis of the flap lies just medial to the
    VASCULAR ANATOMY course of the radial artery at the wrist,
    approximately along a line connecting the
    Septocutaneous perforators from the centre of the antecubital fossa to the radial
    radial artery approach the skin between border of the wrist where the radial pulse

    Radial Forearm Flap  141


    Radial Forearm Flap

    is palpable, approximating to the course of Dividing and ligating the distal artery early
    the artery. Figure 2 makes the flap harvest easier. Figure 4

    The superficial veins are marked with the The pedicle is then traced proximally
    tourniquet tightened. dissecting it free from the overlying
    brachioradialis. A lazy ‘S’ incision over
    The skin incision should begin distally,
    the line of the artery may be used. In this
    u s u a l l y f ro m t h e u l n a r a s p e c t , a n d
    dissection, use an incision over the radial
    dissection proceeds subfascially taking care
    border of the forearm. Figure 5
    to preserve paratenon. Some surgeons
    dissect suprafascially first, changing to a
    deeper level in the proximity of the vessel
    (over the bellies of branchioradialis and
    FCR). Figure 3

    The perforators lie in the ‘septum’ or


    connective tissue between the skin flap
    and artery, between the radial border
    of the flexor carpi radialis and the ulnar
    border of brachioradialis. The septum is
    approached from the radial side in a similar
    manner, preserving the cephalic vein for
    anastomosis when the VC are narrow in
    calibre.

    142 Dissection Manual
    Figure 1
    Cross section anatomy of the forearm Figure 4
    Radial artery (red)
    Cephalic vein (blue)

    Figure 2
    Course of radial artery (red) and flap design (purple)
    Figure 5
    Radial artery

    Figure 3
    Distal radial artery and cephalic vein divided and the
    flap raised with preservation of paratenon

    Radial Forearm Flap  143


    KEY POINTS

    1. This flap consists of fasciocutaneous tissue supplied by


    branches of the radial artery.
    2. Septocutaneous perforators from the radial artery approach
    the skin between the FCR and BR, and drain through venae
    comitantes or the cephalic vein.
    3. A preoperative Allen’s test should be performed.

    4. The skin incision should begin distally and proceed subfascially


    taking care to preserve paratenon.
    5. Dividing and ligating the distal artery early makes the flap
    easier to harvest.

    144 Dissection Manual

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