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Use of free radial forearm and pronator quadratus muscle flap: Anatomical study and clinical application

  • Author Footnotes
    1 Tomáš Kempný and Zuzana Musilová contributed equally to this work.
    Tomas Kempny
    Footnotes
    1 Tomáš Kempný and Zuzana Musilová contributed equally to this work.
    Affiliations
    Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic

    MEDICent Clinic, Na Ctvrti 22, 70300 Ostrava, Hrabuvka, Czech Republic

    Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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  • Author Footnotes
    1 Tomáš Kempný and Zuzana Musilová contributed equally to this work.
    Zuzana Musilova
    Footnotes
    1 Tomáš Kempný and Zuzana Musilová contributed equally to this work.
    Affiliations
    Department of Anatomy – Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
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  • Martin Knoz
    Correspondence
    Corresponding author at: Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic.
    Affiliations
    Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic

    Clinic of Plastic and Aesthetic surgery, St. Anne's University Hospital, Faculty of Medicine, Pekarska 664/53, 602 00 Brno, Czech Republic
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  • Marek Joukal
    Affiliations
    Department of Anatomy – Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
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  • Lipový Břetislav
    Affiliations
    Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic
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  • Holoubek Jakub
    Affiliations
    Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic
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  • Wolfgang Paul Pöschl
    Affiliations
    Department of Oral and Maxillofacial Surgery, Klinikum Wels-Grieskirchen 42, Grieskirchnerstrasse, Wels, Austria
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  • Hsu-Tang Cheng
    Affiliations
    Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, No.222, Fuxin Rd., Wufeng Dist., Taichung, Taiwan

    Big Data Center, China Medical University Hospital, No.2, Yude Rd., North Dist., Taichung, Taiwan

    Department of Food Nutrition and Health Biotechnology, Asia University, 500 Lioufeng Rd., Wufeng Dist., Taichung, Taiwan
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  • Author Footnotes
    1 Tomáš Kempný and Zuzana Musilová contributed equally to this work.
Published:August 23, 2022DOI:https://doi.org/10.1016/j.bjps.2022.08.043

      Summary

      The authors present an anatomical study and clinical experience with radial forearm flap (RFF) and pronator quadratus muscle (PQM) application in the reconstruction of various body areas. The aim was to describe the anatomical placement and proportions of the PQM, the anatomical location of the major arterial branch of the radial artery supplying the PQM, and the application of this knowledge in clinical practice.
      The anatomical study was based upon an analysis of 13 fresh adult cadaver upper extremities, of which nine were female and four male; both arms from the same donors were used in four cases. The study of the PQM was performed using a dye-containing intraarterial injection, standard macro– and micro–preparation techniques, and chemical digestion. The data on the PQM size in males and females, thickness of the radial artery branch (the principal artery nourishing the muscle), and its position were analysed. The radial artery branch nourishing the PQM was identified in all cadaveric specimens of the anatomical study.
      In addition, 12 patients underwent reconstructions of soft and bony tissue defects using a RFF + PQM (pedicled or free flap). The radial artery branch perfusing the PQM was identified in all cases. The flap was used for the management of defects of the head (seven cases), arm (three cases) and lower leg (two cases). The harvest site healed well in all cases and, with the exception of one case in which a partial necrosis of the flap was observed, all flaps remained viable, which demonstrated the safety of the method.

      Keywords

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