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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(01): 063-068
DOI: 10.1055/s-0040-1716421
Original Article

The Vascular Basis of the Pronator Quadratus Muscle Flap and Its Use in Clinical Cases

Binu P. Thomas
1   Dr Paul Brand Centre for Hand Surgery, Christian Medical College & Hospital, Vellore, India
,
Sasi P. Kiran
1   Dr Paul Brand Centre for Hand Surgery, Christian Medical College & Hospital, Vellore, India
,
Maolin Tang
2   Department of Anatomy and Neurobiology and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
,
Christopher R. Geddes
2   Department of Anatomy and Neurobiology and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
,
Steven F. Morris
2   Department of Anatomy and Neurobiology and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract

Background Pronator quadratus (PQ) is a deeply situated muscle in the forearm which may occasionally be utilized for soft-tissue reconstruction. The purpose of this anatomical and clinical study was to confirm vascular supply of PQ muscle (PQM) in order to optimize its transfer and confirm its utility in clinical situations.

Methods In Part A of the anatomical study, fresh human cadavers (n = 7) were prepared with an intra-arterial injection of lead oxide and gelatin solution, and PQM and neurovascular pedicle were dissected (n = 14). In the anatomical study Part B, isolated limbs of embalmed human cadavers (n = 12) were injected with India ink-gelatin mixture and PQ were dissected.

Results PQ is a type II muscle flap, with one major pedicle, the anterior interosseous (AI) vessels and two minor pedicles from the radial and ulnar vessels. The mean dimensions of the muscle were 5.5 × 5.0 × 1.0 cm3, mean pedicle length was 9.6 cm, and the mean diameter of the artery and the vein was 2.3 mm and 2.8 mm, respectively. The dorsal cutaneous perforating branch (DPB) of the artery supplied the skin over the dorsal forearm and wrist. This branch also anastomosed with the 1, 2 intercompartmental supraretinacular artery (ICSRA).

Conclusion This study confirms the potential utility and vascular basis of the PQM flap and its associated cutaneous paddle.

In the clinical part, two patients with nonhealing wounds exposing the median nerve and flexor tendons in the distal forearm were treated using the PQM flap with good results.

Keywords

pronator quadrates - vascular supply of - free muscle transfer - composite flap of - anterior interosseous artery - 1, 2 ICSRA


Publikationsverlauf

Artikel online veröffentlicht:
07. September 2020

© 2020. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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