Year Book: The Distally-Based Brachioradialis Muscle Flap

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McGeorge, DD. Arnstein, PM. Stilwell, JH. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 4-5.|Original Article:|Br J Plast Surg. 1991. 44. pp 30-32.. Background.--Adequate soft tissue coverage of complex hand wounds is a challenge. The use of the brachioradialis muscle for soft tissue cover of the hand and distal forearm was studied. Technique.--The brachioradialis muscle arises from the upper two thirds of the supracondylar ridge of the humerus and the lateral intermuscular septum, and inserts through the flat tendon into the lateral aspect of the distal radius (Fig 4-4). Its blood supply is from branches of the radial artery and variably dominant vascular branches of the recurrent radial artery. With a lazy S incision, the vascular pedicle is exposed and the radial artery, recurrent radial artery, and the brachioradialis muscle are divided proximally and raised as a unit. The vascular pedicle is freed distally, providing a wide arc of rotation to cover any part of the hand. Results.--Two patients were seen with deep abrasion injury to the dorsum of the hand, with exposed metacarpals and extensor tendon loss. Tendon reconstruction was performed with brachioradialis tendon grafts and the muscle to cover the defect. One patient achieved full extensor tendon function, whereas functional result was compromised in the other because of damage to several finger joints. Cosmetic result was good in the first patient. There was no noticeable loss of elbow flexion. Conclusion.--The distally based brachioradialis muscle flap provides soft tissue cover for the hand without the need for microvascular tissue transfer. The brachioradialis tendon can also be used for extensor tendon reconstruction. Its disadvantage of its use is in the division of a main hand artery.