caa a22 4500 463199391 CHVBK 20180405153107.0 cr unu---uuuuu 170326e20070401xx s 000 0 eng 10.1007/s00276-007-0203-7 doi (NATIONALLICENCE)springer-10.1007/s00276-007-0203-7 The proximal radial artery perforator flap (PRAP-flap): an anatomical study for its use in elbow reconstruction [Elektronische Daten] [Cesare Tiengo, Veronica Macchi, Andrea Porzionato, Carla Stecco, Anna Parenti, Franco Bassetto, Raffaele De Caro] We investigated the anatomical vascular basis of the proximal radial artery perforator flap (PRAP-flap) and we report here the first clinical application in a case of reconstructive surgery as an alternative to traditional regional fasciocutaneous pedicled flaps or microsurgery solutions. In 16 unembalmed cadaveric forearms, the radial artery was slowly injected with acrylic resin through the brachial artery and the superficial flexor compartment was dissected. The flap was raised from the lateral and medial sides of the forearm toward the axis represented by the radial artery, and the characteristics (number, diameter, site and interval of origin, and course) of its collaterals were evaluated. In the proximal forearm, the vessels were less numerous (mean values 8.6 vs. 11.5, P<0.05) but larger in diameter (mean values 0.7 vs. 0.4mm, P<0.05) than in the distal forearm. The first four proximal perforator arteries originated within a mean distance of 4.3cm from the origin of the radial artery, with a 95% confidence interval of 3.8-4.8cm. The perforator arteries followed the axis of the forearm and anastomosed in the fascial plane, forming longitudinal fan-shaped arterial chains, giving rise to an epifascial vascular network. This anatomical study allowed us to plan and perform a PRAP-flap in a 35-year-old woman who was suffering from comminuted fractures of the olecranon and distal epiphysis of the humerus and soft tissue loss from traumatic injury of the elbow. From the antebrachial surface, a proximally based radial forearm fasciocutaneous flap was raised, with a vascular pedicle of 16×5cm, a cutaneous island of 4×5cm, and a pivot point 5cm from the interepicondylar line. The flap showed good immediate and long-term viability: it was completely incorporated with good pliability and the patient regained good functional quality of the elbow joint. The anatomical features and the demonstrative reconstructive result obtained in the here-reported surgical case support the clinical evidence that a reliable forearm skin paddle may be raised on a subcutaneous fascial axial pedicle supplied only by proximal perforators of the radial artery. The so-obtained PRAP-flap is useful for the coverage of elbow defects when other reconstructive options are no longer available. Springer-Verlag, 2007 Radial artery nationallicence Perforator flap nationallicence Anatomy nationallicence Elbow reconstruction nationallicence Plastic surgery nationallicence Tiengo Cesare Section of Plastic Surgery, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy aut Macchi Veronica Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut Porzionato Andrea Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut Stecco Carla Orthopaedic and Traumatology Clinic, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy aut Parenti Anna Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut Bassetto Franco Section of Plastic Surgery, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy aut De Caro Raffaele Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut Surgical and Radiologic Anatomy Springer-Verlag 29/3(2007-04-01), 245-251 0930-1038 29:3<245 2007 29 276 https://doi.org/10.1007/s00276-007-0203-7 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00276-007-0203-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tiengo Cesare Section of Plastic Surgery, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy aut NATIONALLICENCE 700 1- Macchi Veronica Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut NATIONALLICENCE 700 1- Porzionato Andrea Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut NATIONALLICENCE 700 1- Stecco Carla Orthopaedic and Traumatology Clinic, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy aut NATIONALLICENCE 700 1- Parenti Anna Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut NATIONALLICENCE 700 1- Bassetto Franco Section of Plastic Surgery, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy aut NATIONALLICENCE 700 1- De Caro Raffaele Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127, Padova, Italy aut NATIONALLICENCE 773 0- Surgical and Radiologic Anatomy Springer-Verlag 29/3(2007-04-01), 245-251 0930-1038 29:3<245 2007 29 276 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer