Pronator Quadratus Pedicled Rotational Flap: Anatomic Feasibility Study for Regional Soft Tissue Coverage of the...

Soft tissue reconstruction using a pronator quadratus pedicled rotational flap (PQPRF) has not been described in detail previously. This cadaveric study assesses surface-area mapping for PQPRF reconstruction and technical considerations for surgical use.

Fresh-frozen trans-humeral cadaveric amputation specimens were used. The PQPRF and its anterior interosseous artery (AIA) pedicle were isolated to assess muscle perfusion and to map the anatomic feasibility of rotational flap coverage. The AIA pedicle was created by its distal to proximal dissection, preserving the distal most flexor pollicis longus neurovascular pedicle to facilitate flap mobilization and simulate flap elevation. Following India ink injection of the brachial artery, muscular perfusion was confirmed. Pronator quadratus pedicled rotational flap dimensions and its rotational arc relative to local anatomy references were measured. Descriptive statistical analyses were reported.

Seven cadaveric specimens were evaluated. Mean PQPRF dimensions were 54 × 37 mm ± 5.8 × 3.5 mm. Anterior interosseous artery pedicle length was 84 ± 17 mm. Pronator quadratus pedicled rotational flap rotational arc observed was: distal: 8 ± 6.9 mm proximal to the radial styloid and 20 ± 13.2 mm proximal to the ulnar styloid; the flap covered dorsal and radial to the mid-sagittal line of the radial forearm 38.6 ± 24.7 mm. In a proximal direction, the flap covered up to 44.3 ± 31.6 mm distal to the medial epicondyle. Dorsal forearm and wrist coverage using the PQPRF via an interosseous membrane window was measured to 9.2 ± 7.1 mm distal to Lister's tubercle.

The PQPRF is reliably perfused based on an anterograde AIA vascular supply and is a variable but useful option for wrist and forearm soft tissue reconstruction.