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Unusual anomaly of the radial artery encountered during the elevation of a radial forearm free flap: a case report

  • Jin Myung Yoon (Department of Plastic and Reconstructive Surgery, Inha University Hospital) ;
  • Tae Jun Park (Department of Plastic and Reconstructive Surgery, Inha University Hospital) ;
  • Sae Hwi Ki (Department of Plastic and Reconstructive Surgery, Inha University Hospital) ;
  • Min Ki Hong (Department of Plastic and Reconstructive Surgery, Inha University Hospital)
  • Received : 2022.11.15
  • Accepted : 2023.02.20
  • Published : 2023.02.20

Abstract

The radial forearm free flap (RFFF) has become popular for head and neck reconstructions. Owing to a constant anatomy the RFFF is relatively easy to dissect. Nevertheless, anatomical variations of the radial artery have been reported. Some variations could affect the survival of the flap. This paper reports an unusual anomaly of the radial artery where the radial artery was not located between the brachioradialis (BR) and flexor carpi radialis. The radial artery was observed above the BR and on the radial side of the BR. The survival of the elevated flap was deemed questionable because it had only few perforators. So we decided to discard the flap and to elevate another free flap for the head and neck defect. The donor area on the forearm was covered using the original skin of the first flap as a full-thickness skin graft. This case highlights a means to deal with anomalies of the radial artery encountered during the elevation of RFFF and the checking process for variations of the radial artery before RFFF.

Keywords

References

  1. Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofac Surg 2021;22:38-44.  https://doi.org/10.7181/acfs.2020.00745
  2. Choi JW, Alshomer F, Kim YC. Current status and evolution of microsurgical tongue reconstructions, part I. Arch Craniofac Surg 2022;23:139-51.  https://doi.org/10.7181/acfs.2022.00654
  3. Mccormack LJ, Cauldwell EW, Anson BJ. Brachial and antebrachial arterial patterns; a study of 750 extremities. Surg Gynecol Obstet 1953;96:43-54. 
  4. Uglietta JP, Kadir S. Arteriographic study of variant arterial anatomy of the upper extremities. Cardiovasc Intervent Radiol 1989;12:145-8.  https://doi.org/10.1007/BF02577379
  5. Hoffman RD, Danos DM, Lin SJ, Lau FH, Kim PS. Prevalence of accessory branches and other anatomical variations in the radial artery encountered during radial forearm flap harvest: a systematic review and meta-analysis. J Reconstr Microsurg 2020;36:651-9.  https://doi.org/10.1055/s-0040-1713600
  6. Sasaki K, Nozaki M, Aiba H, Isono N. A rare variant of the radial artery: clinical considerations in raising a radial forearm flap. Br J Plast Surg 2000;53:445-7.  https://doi.org/10.1054/bjps.1999.3294
  7. Yokoyama N, Takeshita S, Ochiai M, Koyama Y, Hoshino S, Isshiki T, et al. Anatomic variations of the radial artery in patients undergoing transradial coronary intervention. Catheter Cardiovasc Interv 2000;49:357-62.  https://doi.org/10.1002/(SICI)1522-726X(200004)49:4<357::AID-CCD1>3.0.CO;2-Z
  8. Martin-Granizo R, Gomez F, Sanchez-Cuellar A. An unusual anomaly of the radial artery with potential significance to the forearm free flap. Case report J Craniomaxillofac Surg 2002;30:189-91.  https://doi.org/10.1054/jcms.2002.0300
  9. Bhatt V, Green J, Grew N. Dealing with aberrant vessels in radial forearm flaps: report of a case and review of literature. J Craniomaxillofac Surg 2009;37:87-90. https://doi.org/10.1016/j.jcms.2008.11.005