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Multidetector-Row Computed Tomographic Analysis of the Superficial Palmar Branch of Radial Artery Perforator Flaps
Nguyen Doan Tien Linh1, Shimpei Ono1, Goh Akiyama1
1From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital; Department of Radiology, Graduate School of Nippon Medical School; and Plastic, Reconstructive, and Aesthetic Surgery Center, National Burn Hospital.
Background:
Soft-tissue defects in the hand and digits can be effectively covered by using the free superficial palmar branch of the radial artery (SPBRA) flap, which is harvested from the radial volar wrist. Because previous anatomical studies on this flap are limited, multidetector-row computed tomographic angiography of the upper limbs was conducted to characterize the three-dimensional anatomical structure of the SPBRA and its perforators in living patients.
Methods:
This retrospective anatomical study was conducted from 2014 to 2019. All data from Digital Imaging and Communications in Medicine were analyzed by using their viewer. SPBRA diameter and the location where it bifurcated from the radial artery were recorded, as were the number, location, branching patterns, and diameters of its perforators and their lengths.
Results:
In total, 30 patients met all eligibility criteria. All had the SPBRA. The vessel bifurcated from the radial artery on average 13.2 mm proximally from the radial styloid process. The 30 patients had 40 SPBRA perforators in total. Their average SPBRA-to-dermis length was 6.43 mm. All patients had at least one direct cutaneous perforator. Nine and one also had one musculocutaneous perforator and another direct perforator, respectively. All direct cutaneous perforators were located inside a 16.4-mm-diameter circle with an origin on the scaphoid tubercle. The mean diameters of the SPBRA and its perforators were 1.12 and 0.62 mm, respectively.
Conclusions:
All patients had at least one reliable SPBRA perforator in the radial volar wrist. The authors' results suggest that plastic surgeons can easily and safely plan the SPBRA flap design, potentially without preoperative perforator mapping.
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