DISTAL DORSAL FOREARM FLAP

The goal of this study was to investigate the vascular supply of the d istal dorsal forearm and the feasibility of using a local skin flap ba sed on perforating vessels of the anterior interosseous artery (AIA) t o reconstruct the dorsal aspect of the hand. The results of anatomic s tudies on 71 adult, fresh-frozen cadaveric upper extremities indicate that a new flap can be designed based on a cutaneous branch of the AIA . The AIA runs along the volar surface of the anterior interosseous me mbrane. At the proximal border of the pronator quadratus muscle it giv es off a dorsal septocutaneous branch (DSCB) that pierces the inteross eous membrane and supplies the extensor muscles of the thumb and the s kin of the distal two-thirds of the dorsal forearm. The average artery diameter at the origin of the DSCB was 1.1 +/- 0.2 mm (mean +/- stand ard error of mean). The mean pedicle length was 3.1 +/- 0.6 cm. The pe dicle could be extended to 12.4 +/- 0.9 cm if the entire AIA was inclu ded. Based an dye injection studies, the smallest skin paddle that cou ld be supported by this vessel ranged from 5 x 9 cm to 8 x 15 cm. The flap can be configured as an island vascular flap based on the DSCB or AIA, a distally based flap, a free flap, a fascial flap, or a composi te flap including muscle, bone, nerve, and skin.