The median artery: its potential implications for the radial forearm flap

The median artery is an infrequent anomaly with a highly variable origin and course in the forearm. It is associated with other local anatomical variations, and may contribute significantly to the superficial palmar arch. We describe the incidental finding of a palmar median artery during harvesting of a radial forearm flap despite normal preoperative Allen's test and colour Doppler ultrasonography. A review of the anatomy and embryology suggests that there is an association of a persistent palmar median artery and an incomplete palmar arch, and that the median artery may arise from the radial artery, leading to an increased risk of hand ischaemia if it is sacrificed during harvesting. In this case the origin of the median artery was not encountered, and the patient did not develop ischaemia. We suggest that in the event of finding such an artery, the surgeon must be vigilant in order to ensure its origin is not ligated during harvesting.