Anomalies of forearm vascular anatomy encountered during elevation of the radial forearm flap.

Background: The radial forearm flap has gained considerable popularity over the past 10 years. With the increasing number of forearm flaps being used in head and neck reconstruction, it is likely that anomalous forearm vascular anatomy will be encountered by more head and neck surgeons performing this procedure.

Methods: We reviewed our experience with 52 forearm flaps; four different anomalies of forearm vascular anatomy were encountered in four patients. In this article we present each of our cases and discuss the incidence, preoperative diagnosis, and recommended management of these and the more common forearm vascular anomalies.

Results: The anomalies encountered in our series include: one case of distal takeoff of the radial artery deep to the pronator teres muscle, two cases of a superficial dorsal antebrachial artery, one case of bilateral hypoplastic ulnar arteries, and one case of high takeoff of the radial artery.

Conclusions: There are a number of anomalies of forearm vascular anatomy of clinical significance to the surgeon performing these procedures. Most of these anomalies can be identified with a careful preoperative examination. Surgeons performing this procedure should be familiar not only with the normal vascular anatomy of the forearm flap, but also with the more common anatomic variants. Failure to recognize or appropriately manage these anomalies of forearm vascular anatomy may result in a compromised surgical outcome.