Arch Hand Microsurg.  2022 Dec;27(4):296-299. 10.12790/ahm.22.0047.

Proximal bifurcation of the superficial palmar branch of the radial artery and anomalous superficial course of the distal radial artery: a case report

• Choi YS
• You HJ

• KMID: 2536215
• DOI: http://doi.org/10.12790/ahm.22.0047

Abstract

Variations of the radial artery are rare, but clinically significant for surgeons when raising a radial forearm free flap. A 68-year-old man presented with an anomaly of the radial artery, which had a proximal bifurcation of the superficial palmar branch and an anomalous superficial course of the distal radial artery, mimicking duplication of the radial artery. A bifurcation of the main vessel was detected approximately 7 cm proximal to the wrist crease. Anastomosis was performed by using the superficial palmar branch of the radial artery. After anastomosis, the anomalously bifurcated deep palmar branch of the radial artery was transected 1 cm distal to the bifurcation. Although variations, such as unusual bifurcations of the radial artery, are extremely rare, surgeons should be aware of possible variations to ensure safe flap harvesting.

Keyword

Radial artery; Radial forearm free flap; Head and neck neoplasms; Anatomic Variant; Reconstructive surgical procedures; Microsurgery

Figure

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  Fig. 1. Dissected radial artery and vein between the flexor carpi radialis muscle (white arrows) and the brachioradialis muscle (white arrowheads). Proximal bifurcation of the radial artery into the superficial palmar branch (yellow arrows) and the dorsal carpal branch (yellow arrowheads).

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  Fig. 2. Elevated radial forearm free flap.

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  Fig. 3. Schematic courses of previously reported anomalies. (A) Normal course of the radial artery (RA). (B) RA branching not from the brachial artery (BA), but from the common interosseous artery (CIA). (C) Aberrant collateral RA. (D) Proximal bifurcation of the superficial palmar branch of the RA (SPB). UA, ulnar artery; DPB, deep palmar branch of the RA; ACA, aberrant collateral radial artery.

Reference

References

1. Acarturk TO, Newton ED. Aberrant branch of the radial artery encountered during elevation of the radial forearm free flap. J Reconstr Microsurg. 2004; 20:611–4.

2. Breik O, Selbong U, Laugharne D, Jones K. Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature. Int J Oral Maxillofac Surg. 2019; 48:1509–15.

3. Martín-Granizo R, Gómez F, Sánchez-Cuéllar A. An unusual anomaly of the radial artery with potential significance to the forearm free flap. Case report. J Craniomaxillofac Surg. 2002; 30:189–91.

4. Raviprasanna KH, Krishna Das A, Kulkarni AL. Radial artey: anatomical variations at wrist and clinical significance. Int J Anat Res. 2019; 7:6740–3.

5. Tagil SM, Bozkurt MC, Kuvat SV, Cicekcibasi AE. A variant course of the superficial palmar branch of the radial artery. Surg Radiol Anat. 2012; 34:871–3.

6. Wadhwa S, Tomar V. Anomalous medial branch of radial artery: a rare variant. Acta Medica (Hradec Kralove). 2016; 59:100–3.

7. Weinand C, Akbari C, O'Donnell S. A high bifurcation of the dorsal branch with dominant superficial palmar branch of the radial artery: a case report of an aberrant radial artery with traumatic aneurysm. J Hand Microsurg. 2011; 3:78–81.

8. Rodríguez-Niedenführ M, Burton GJ, Deu J, Sañudo JR. Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat. 2001; 199(Pt 4):407–17.

9. Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP. Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. Ann Thorac Surg. 2004; 77:116–9.

10. Bumbasirević M, Lesić A, Filipović B. Duplication of the radial artery in the radial forearm flap. Clin Anat. 2005; 18:305–7.