Superficial palmar branch of radial artery flap for digital skin reconstruction: anatomical study and clinical applications

Abstract

BackgroundThis study investigates the anatomy of the superficial palmar branch of the radial artery (SUPBRA) for palmar skin reconstruction. It aims to detail SUPBRA's anatomical features for hand/finger reconstruction and pinpoint reference points for efficient harvesting.Materials and methodsNineteen male hand specimens (aged 18-70 years), fixed in 10% formalin, were dissected to study the anatomy of SUPBRA island flap. All measurements such as the external diameter of the SUPBRA, its bifurcation point from the radial artery, length of the SUPBRA pedicle, accompanied by venae comitantes, the number and location of perforators were used analyzed. Two flap techniques based on SUPBRA, the mid-palmar axis and wrist line axis, were studied. SUPBRA flap designs were used in three hand injury cases.ResultsThe distance from SUPBRA's origin to the styloid process averaged 9.4 +/- 1.1 mm, and its mean diameter was 2.4 +/- 1.5 mm. It has not been encountered a pattern with a narrow diameter of 1.1 mm or less, which is considered hypoplastic and unsuitable for a flap due to inadequate nourishment, in SUPBRA. Mean length of the SUPBRA pedicle was 31.0 +/- 6.3 mm. The SUPBRA was typically accompanied by two vena comitantes. The location of the musculocutaneous perforators, approximately 10 mm distal to the scaphoid tubercle, suggests that when the SUPBRA flap is designed transversely along the distal wrist crease, the direct cutaneous perforators will play a crucial role in providing adequate blood supply to the flap as a pedicle. Flap sizes ranged from 1.5 x 3.0 mm to 2.5 x 6.5 mm. To obtain a longer pedicle, the flap was designed with a long-skin pattern along the long-axis direction, and the accompanying veins were dissected proximally to the radial artery. All cases confirmed the SUPBRA flap's viability for microvascular anastomosis in the thenar regions.ConclusionSUPBRA flap isa valuable option for hand and finger reconstruction,. providing detailed anatomical insights, including its external diameter, bifurcation point from the radial artery, flap length, presence of venae comitantes, and the number and locations of perforators. This flap is particularly suitable for reconstructing palmar defects of the radial digits, palm, and first webspace, and its arterial dimensions and lengths make it well-suited for microvascular anastomosis.