[Successful free microvascular radial artery flap for phalloplasty in case of a persistent median artery - Retrospective analysis of 48 patients and review of the literature].

BACKGROUND

Anomalies of the radial arterial system can be of importance during harvesting of a radial forearm flap. In particular when using the forearm flap for phalloplasty due to the required dimensions of the flap, sufficient arterial supply is of fundamental importance. In case of a persistent median artery perfusion conditions in the supply area of ​​the A. radialis and the A. ulnaris may have been altered or even completely regressed.

METHODS

A retrospective evaluation of all phalloplasties performed in our institution was carried out from January 2016 to December 2018. In all patients technique according to Gottlieb and Levine or Chang was applied.

RESULTS

In the retrospectively evaluated population of 48 patients, a persistent arteria mediana was found intraoperatively in two patients, corresponding to an incidence of 4.2 %. In both patients, the phalloplasty was accomplished without restriction of flap perfusion or hand perfusion. A review of the literature provides an overview of the incidence of aberrant vascularization of the forearm and the consequences that can be derived for the planning of a radial artery flap.

CONCLUSION

Variations in the arterial anatomy of the forearm, as the presence of a persistent median artery, are sufficiently common to warrant careful preoperative evaluation when planning a free vascularized forearm flap for reconstructive surgery. The preoperative performed Allen-test provides no clear inference possibility and therefore often requires intraoperative random findings. The reconstructive surgeon should be aware of these possible variations because it can affect the harvest and the survival of the forearm flap as well as causing ischaemia of the hand.