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Ulnar and radial arteries perforator-based flaps: a cadaveric study and scoping review with narrative synthesis

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Abstract

Background

Forearm perforator flaps are fascio-cutaneous flaps that are widely used to cover defects of the hand and forearm. It is critical to include a perforator in these flaps while harvesting them; hence, an understanding of the anatomy is the key. This study aims to map the location of the cutaneous perforators that arise from the radial and ulnar arteries in the cadaveric forearm.

Methods

Eleven fresh frozen healthy Caucasian cadaveric forearms purposed for medical research (8 left, 3 right) of mean age 57.1 were used. The radial and ulnar arteries were identified proximally, cannulated, and clamped. An Indian ink, gelatin, and purified water solution were instilled under hand pressure. Specimens were then dissected, and radial and ulnar arteries and their perforators were identified. The location of the perforators was measured relative to the radial and ulnar styloid.

Results

A total of 95 perforators were identified (54 radial, 41 ulnar). The average number of radial and ulnar artery perforators is 5 ± 2 and 4 ± 2 respectively. The most distal radial and ulnar perforator arteries are located at 30 mm (13–56) and 25 mm (8–42) respectively.

Conclusions

There are more cutaneous perforators arising from the radial than the ulnar arteries. It may be safe to harvest the flaps based on their distance from the distal radius/ulna without having to intra-operatively identify the perforators and avoid the risk of their injury.

Level of evidence

Not ratable.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore

    Usama Farghaly Omar, Jingwen Ng, Wei Ping Sim & Vaikunthan Rajaratnam

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  1. Usama Farghaly Omar
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Corresponding author

Correspondence to Usama Farghaly Omar.

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Ethics approval

This study was conducted after obtaining institutional research board approval (NHG DSRB Reference number 2020/00081).

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Obtained from all the relatives or legal guardians of the cadavers donated to science for biomedical research.

Conflicts of interest

Usama Farghaly Omar, Ng Jingwen, Sim Wei Ping, and Vaikunthan Rajaratnam declare no competing interests.

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Omar, U.F., Ng, J., Sim, W.P. et al. Ulnar and radial arteries perforator-based flaps: a cadaveric study and scoping review with narrative synthesis. Eur J Plast Surg 46, 77–84 (2023). https://doi.org/10.1007/s00238-022-01966-x

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  • DOI: https://doi.org/10.1007/s00238-022-01966-x

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