Anatomical basis for a vascular pedicled island flap from the dorsal area of the wrist.

We explored the cutaneous vascularity of the dorsal wrist area to examine the possibility of using reverse island flaps from this area for reconstruction of the hands and fingers. Four dominant arterial branches including the dorsal branches of the ulnar and radial arteries and terminal branches of the anterior and posterior interosseous arteries, which supplied the dorsal skin over the extensor retinaculum, were explored. The location, number, and diameter of skin perforators from these arteries were examined. The dorsal branches of the radial and ulnar arteries that passed along the dorsal cutaneous nerves gave off 2-4 skin perforators (diameter 0.1-0.2 mm) at the level of the carpal bone and always connected distally to perforating arteries from the palmar arterial system at the metacarpal head. Skin perforators from the anterior and posterior interosseous arteries were found passing through the extensor retinaculum in the second and third and fifth and sixth intercompartmental areas. The terminal branches of the anterior and posterior interosseous arteries always continued to the dorsal carpal arch, and lay over the distal carpal row. It may be anatomically possible to raise two different island flaps from the dorsum of the wrist.