Dorsal branches of superficial radial nerve: an anatomic study with potential clinical applications

An anatomical study was performed to assess the course of the dorsal branch es of superficial radial nerve and to investigate potential clinical applic ations in hand surgery. Eight upper extremities were dissected, using an op erating microscope. All branching points of the superficial radial nerve we re noted and the distances from the radial styloid process were recorded. T heir proximity to neighboring vascular structures was noted. The superficia l branches of the radial nerve can vascularize axial neurofasciocutaneous f laps via their paraneural arterial network. In addition, various reverse ne urofasciocutaneous flaps may be harvested, based on dorsal branches of the superficial radial nerve. The nerve can be anastomosed with a suitable nerv e in the recipient area. The dorsal branches of the superficial radial nerv e can easily be added to the reverse first dorsal metacarpal artery flap an d other reverse dorsal metacarpal artery flaps, thus making it possible to form a sensate flap. These branches may be anastomosed with nerves in the r ecipient site, such as dorsal branches of digital nerve stump, without sign ificant donor site morbidity. A free sensate first dorsal artery flap can b e prepared with a combination of dorsal branches of the superficial radial nerve and used with the same indications as a free digital artery flap. It has some advantages over the free digital artery flap, because the main neu rovascular structures of the finger are kept intact. Finally, a dorsal nerv e branch which accompanies the first dorsal metacarpal artery may be harves ted with this artery and a subcutaneous dorsal vein as vascularized nerve g raft. It can be used to repair a digital nerve defect in dense scar tissue.