The distally based radial artery/flexor carpi radialis muscle flap for dorsal hand reconstruction: a clinical and cadaver study

Complex soft tissue defects of the hand often require vascularized tissue for protection and coverage of exposed underlying structures. Pedicled local flaps from the forearm are one reconstructive option, but its use is limited by relatively high donor-site problems, including a disagreeable forearm scar and potential division of superficial forearm nerves. We describe a pedicled local flap option--the distally based radial artery/flexor carpi radialis flap, which potentially decreases forearm donor-site morbidity while still providing for coverage of small hand soft tissue defects. Six cadaver forearm dissections were performed to confirm that the vascular supply to the middle and distal portion of the flexor carpi radialis comes off the radial artery. Four clinical cases are presented in which the flexor carpi radialis muscle based on the distal radial artery was used to cover complex wounds of the dorsum of the hand. We believe the lack of damage to the superficial sensory forearm nerves and the ease of flexor carpi radialis muscle flap elevation make this a versatile flap for small, complex, soft tissue defects of the hand.