Applied anatomy of the compound flap pedicled with nutritional vessels of the posterior cutaneous nerve of forearm

Objective: To provide anatomic basis for projecting distally-based flap(periosteum) pedicled with nutritional vessels of the posterior cutaneous nerve of forearm. Methods: The origin, branches and anastomosis of the posterior cutaneous nerve of forearm and its relationship with ulnar and radial periosteal vessels were observed on 30 superior limb specimens of adult cadaver perfused with red gelatin in the artery. Results: The origin of nutritional vessels of the posterior cutaneous nerve of forearm was as follows: the cutaneous branches of radial collateral vessels (2～6 branches) with external diameter of (0.6±0.3)mm; cutaneous branches of posterior interosseous artery (6～9 branches) with external diameter of (0.7±0.3)mm; cutaneous branches of dorsal carpal branch of anterior interosseous artery (3～5 branches) with external diameter of (0.8±0.2)mm; cutaneous branches of dorsal carpal branch of ulnar artery and radial artery (2～6 branches) with external diameter of (0.6±0.1)mm. Periosteal vessels of midpiece and superior segment of ulna came form muscular and periosteal branches of posterior interosseous artery, which was about 6～8 branches and its external diameter was (0.3～1.0)mm. The bone cutaneous branches of posterior interosseous artery anastomosed with periosteal vessels of exposed area of midpiece of radius. Perforating branches mentioned above included fascia branches, cutaneous branches, periosteal branches and the branches of cutaneous nerve and subcutaneous vein. Vessel chain of the trunk of cutaneous nerve and the net of deep subcutaneous fascia and periosteal vessels were formed. Conclusions: The results suggest that the nutritional vessels of the posterior cutaneous nerve of forearm and the nutritional vessels of bone and skin have homology. The distally-based compound flap pedicled with nutritional vessels of the posterior cutaneous nerve of forearm with the rotation point at the wrist joint can be applied to repair soft tissues defect of distant part of the dorsum of hand.