The lateral antebrachial neurocutaneous flap with determining the location of the distal perforator branches of the radial artery for treating hand soft tissue defects

Researchers have extensively studied the anatomy and clinical applications of the lateral antebrachial neurofasciocutaneous flap, which uses distal perforator branches of the radial artery for treating hand soft tissue defects. This flap can cover extensive wounds, preserve major blood vessels, maintain good viability, and involve straightforward dissection. However, there is no consensus on the optimal pivot point location for this flap in covering hand soft tissue defects. Additionally, no studies have examined the distal vascular pedicle location of the radial artery to identify the suitable perforator branch as the pivot point for treating such defects. This study aimed to determine the appropriate distal perforator location of the radial artery as the pivot point of the flap for treating hand soft tissue defects, contributing to the evaluation of this flap's effectiveness in reconstructing hand soft tissue defects

This prospective case series study used the lateral antebrachial neurofasciocutaneous flap to identify the appropriate distal perforator location of the radial artery as the pivot point for reconstructing hand soft tissue defects with exposed tendons or bones. Participants were followed for at least six months, with the longest follow-up being 29 months. The study was conducted at the Hospital for Traumatology and Orthopedics in Ho Chi Minh City, Vietnam

Thirty-three of the thirty-five flaps (94.3%) survived. Only two flaps (02/35) suffered from distal superficial necrosis due to venous congestion. The pivot point was located 4 cm above the radial styloid process in 26 flaps and 6 cm above the radial styloid process in 9 flaps. This flap demonstrated efficacy in covering various sides of the hand without complications and sequelae in the donor sites and hand wounds.

Determining the location of the distal perforators of the radial artery is crucial for harvesting the lateral antebrachial neurofasciocutaneous flap. This study revealed a high success rate with a larger sample size compared to previous studies. The results showed that the appropriate location of the perforating branch of the radial artery acts as a favorable pivot point for flap design, which enhances the coverage effectiveness of the flap based on the location and size of the hand soft tissue defects. The pivot point can be easily determined by examining the anatomy of these distal branches.

The distally based lateral antebrachial neurofasciocutaneous flap, which takes into account the location of the distal perforators of the radial artery, is a valuable option for covering hand soft tissue defects without complications and sequelae in the donor sites and hand wounds. This study confirms that this method is an appropriate and promising technique for treating hand soft-tissue defects. Further research, including studies with control groups, larger sample sizes, and multiple hospitals in Vietnam, may be warranted to validate this method's effectiveness

Keywords: distally radial artery perforator flap, lateral antebrachial neurofasciocutaneous flap based on the distal perforator branches of the radial artery, distally based lateral antebrachial neurofasciocuta