School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Department of Behavioral and Community Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
J Reconstr Microsurg. 2020 Nov;36(9):651-659. doi: 10.1055/s-0040-1713600. Epub 2020 Jun 24.
Harvest of the radial forearm flap (RFF) for reconstructive surgery is proceeded by the Allen test to assess for adequate contralateral perfusion of the hand, yet the Allen test may fail to detect anatomical variations in the radial artery such as aberrant branching. Therefore, the goal of this study was to systematically review the literature regarding anatomical abnormalities of the radial artery that can affect flap harvest and to perform a meta-analysis to estimate the prevalence of such abnormalities.
A systematic review of the literature was conducted using five online databases to identify all instances of radial artery anatomical variations. Abstracts were reviewed and categorized into either (1) large cohort studies of anatomical variations identified by angiogram or (2) case reports specifically mentioning anomalous or accessory branches of the radial artery. Data from the large cohort studies were included in a random effect meta-analysis to estimate the prevalence of such variations.
Eighteen angiogram cohort studies containing a total of 18,115 patients were included in the meta-analysis. Accessory branches were the least common anatomical variant reported, with an estimated average prevalence of 0.5%. Prevalence estimates for more common anatomical variants, including radial artery loops (0.9%), stenosis (1.3%), hypoplasia (1.9%), tortuosity (4.3%), and abnormal origin (5.6%), were also calculated. Thirteen case reports detailing anomalous branches of the radial artery were identified, seven of which involved accessory branches encountered during RFF harvest with no incidence of flap loss.
Radial artery accessory branches are exceedingly rare, but the prevalence of other anatomical variations that can affect harvest of the RFF warrants consideration. We recommend surgeons consider comprehensive screening prior to RFF harvest to avoid intraoperative discovery of anatomical variants and suggest a low threshold for repeat perfusion testing intraoperatively if radial artery accessory branches are encountered.
为了进行重建手术，桡侧前臂皮瓣（RFF）的采集需要进行 Allen 试验来评估手部的对侧灌注是否充足，但 Allen 试验可能无法检测到桡动脉的解剖变异，如异常分支。因此，本研究的目的是系统地回顾关于可能影响皮瓣采集的桡动脉解剖异常的文献，并进行荟萃分析以估计此类异常的发生率。
使用五个在线数据库进行系统的文献回顾，以确定所有桡动脉解剖变异的实例。审查摘要并将其分为两类：（1）通过血管造影术识别的解剖变异的大队列研究，或（2）专门提到桡动脉异常或副支的病例报告。大型队列研究的数据被纳入随机效应荟萃分析，以估计此类变异的发生率。
共纳入 18 项血管造影队列研究，共包含 18115 名患者。副支是报告的最不常见的解剖变异，估计平均发生率为 0.5%。还计算了更常见的解剖变异的发生率估计值，包括桡动脉环（0.9%）、狭窄（1.3%）、发育不良（1.9%）、迂曲（4.3%）和异常起源（5.6%）。确定了 13 份详细描述桡动脉异常分支的病例报告，其中 7 份涉及在 RFF 采集过程中遇到的副支，没有皮瓣丢失的病例。
桡动脉副支极为罕见，但会影响 RFF 采集的其他解剖变异的发生率值得考虑。我们建议外科医生在进行 RFF 采集之前进行全面筛查，以避免术中发现解剖变异，如果遇到桡动脉副支，建议术中重复进行灌注测试。
