A Cadaveric Anatomy Study of the Shape-Modified Radial Forearm Flap

PURPOSE: Mateev developed a shape-modified radial forearm flap (SMRFF), the use of which is not widespread. This study aimed to analyze hand subunit defects and combinations thereof that can be reconstructed using the SMRFF. METHODS: An anatomical study of 10 injected cadavers was conducted to investigate the subunits and combinations reachable with SMRFF. The radial pedicle length, the number and locations of radial artery perforators, the skin flap's dimensions and surface area, and the number, dimension, and surface area of skin paddles were recorded. RESULTS: In all 10 cadavers, the dorsum, the palm, all combinations of palmar subunits, and both sides of the first webspace could be covered. Two dorsal proximal phalanges could be covered only when adjacent. The mean radial pedicle length was 19.3 cm. All perforators (diameter > 0.5 mm) were septocutaneous, ranging from 3 to 9 per artery (mean: 6.3). On average, there were two perforators in the proximal third of the forearm, 2.3 in the middle third, and two in the distal third. At the proximal third of the forearm, the mean distance between the lateral epicondyle and the perforator was 6.6 cm. At the middle third of the forearm, this distance was 11.8 cm. At the distal third of the forearm, the mean distance between the perforator and the radial styloid process was 4.3 cm. The mean flap surface area was 98.4 cm2, with 34.4 cm2 for proximal paddles, 28.2 cm2 for middle paddles, and 22.8 cm2 for distal paddles. CONCLUSIONS: The SMRFF can effectively reach various hand subunit defects, offering versatile coverage for palmar and dorsal regions, with detailed perforator and flaps measurements. CLINICAL RELEVANCE: This study investigates the anatomical feasibility of the SMRFF and demonstrates its adaptability, making it a potentially valuable tool in hand surgery.

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In 10 injected cadavers, the shape-modified radial forearm flap reached the dorsum, palm, all palmar subunit combinations, and both sides of the first webspace, with a mean pedicle length of 19.3 cm and mean flap surface area of 98.4 cm².

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