Presentation of angiosome-supplying vessels of the radial artery in preoperatively prepared angiographies prior to radial forearm flap surgery

Introduction The free radial forearm flap (RF) is versatile and often used in head and neck tumor surgery for defect coverage. Sufficient perfusion of the free flap is necessary for an optimal result, whereby the radial artery ensures the blood circulation of the angiosomes via supplying vessels (source arteries - SA). The aim of this work was to find out whether these vessels can be visualized in forearm angiographies in order to be able to plan the optimal collection site and scope preoperatively.

Method A total of 41 preoperatively prepared angiographies from 21 patients between 2016-2019 were evaluated on the number and distribution of the supplying vessels of the RF.

Results A total of 221 SA could be identified, 102 SA were seen in the proximal half of the radial artery, 119 in the distal half. On average, 5.39 (0-14) SA could be imaged per artery, 2,49 (0-8) SA in the proximal half and 2,9 (0-10) in the distal half. A correlation between SA density and postoperative outcome was not found.

Discussion The concept of angiosomes, first described by Taylor and Palmer, is the subject of much controversy, with evidence supporting the direct revascularization of the skin and underlying tissue respecting the angiosomes. Methodical weakness lies in the rigid definition of the angiosomal territories, which do not consider anatomical variants as well as the collateral networks. Based on our data and to our knowledge, we were able to detect a high variance of the source arteries and thus probably also of the angiosomes of the forearm for the first time. Further prospective investigations are required to transfer this data to everyday clinical practice.

Poster-PDF A-1336.PDF

Publication History

Article published online:
10 June 2020