Subscribe to RSS
The Vascular Basis of the Pronator Quadratus Muscle Flap and Its Use in Clinical Cases
Background Pronator quadratus (PQ) is a deeply situated muscle in the forearm which may occasionally be utilized for soft-tissue reconstruction. The purpose of this anatomical and clinical study was to confirm vascular supply of PQ muscle (PQM) in order to optimize its transfer and confirm its utility in clinical situations.
Methods In Part A of the anatomical study, fresh human cadavers (n = 7) were prepared with an intra-arterial injection of lead oxide and gelatin solution, and PQM and neurovascular pedicle were dissected (n = 14). In the anatomical study Part B, isolated limbs of embalmed human cadavers (n = 12) were injected with India ink-gelatin mixture and PQ were dissected.
Results PQ is a type II muscle flap, with one major pedicle, the anterior interosseous (AI) vessels and two minor pedicles from the radial and ulnar vessels. The mean dimensions of the muscle were 5.5 × 5.0 × 1.0 cm3, mean pedicle length was 9.6 cm, and the mean diameter of the artery and the vein was 2.3 mm and 2.8 mm, respectively. The dorsal cutaneous perforating branch (DPB) of the artery supplied the skin over the dorsal forearm and wrist. This branch also anastomosed with the 1, 2 intercompartmental supraretinacular artery (ICSRA).
Conclusion This study confirms the potential utility and vascular basis of the PQM flap and its associated cutaneous paddle.
In the clinical part, two patients with nonhealing wounds exposing the median nerve and flexor tendons in the distal forearm were treated using the PQM flap with good results.
Keywordspronator quadrates - vascular supply of - free muscle transfer - composite flap of - anterior interosseous artery - 1, 2 ICSRA
07 September 2020 (online)
© 2020. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Rath S, Hung LK, Leung PC. Vascular anatomy of the pronator quadratus muscle-bone flap: a justification for its use with a distally based blood supply. J Hand Surg Am 1990; 15 (04) 630-636
- 2 Leung PC, Hung LK. Use of pronator quadratus bone flap in bony reconstruction around the wrist. J Hand Surg Am 1990; 15 (04) 637-640
- 3 Dellon AL, Mackinnon SE. The pronator quadratus muscle flap. J Hand Surg Am 1984; 9 (03) 423-427
- 4 Kawai H, Yamamoto K. Pronator quadratus pedicled bone graft for old scaphoid fractures. J Bone Joint Surg Br 1988; 70 (05) 829-831
- 5 Lee JC, Lim J, Chacha PB. The anatomical basis of the vascularized pronator quadratus pedicled bone graft. J Hand Surg [Br] 1997; 22 (05) 644-646
- 6 Dautel G, Merle M. Pronator quadratus free muscle flap for treatment of palmar defects. J Hand Surg [Br] 1993; 18 (05) 576-578
- 7 Marshall MP, Gutheil JP. Pronator quadratus flap for burn reconstruction. J Burn Care Rehabil 2004; 25 (06) 519-522
- 8 Lee WPA, Idler RS. Functional transfer of pronator quadratus free flap for thenar muscle loss. J Reconstr Microsurg 1996; 12 (02) 77-80
- 9 Quatra F, Romeo OM, Lowemberg D, Brooks D, Buncke HJ. Functional transplantation of the pronator quadratus muscle for facial reanimation. A small muscle for a small job. Presented at the Plastic Surgery Research Council 47th Annual Meeting 2002
- 10 Tang ML, Geddes CR, Yang D, Morris SF. Modified lead oxide - gelatin technique for vascular studies. J Clin Anat. 2002; 1: 73-78
- 11 Salmon M. Arteres de la Peau. Paris: Masson et Cie; 1936
- 12 Salmon M. Arteries of the muscles of the extremities. P 89. In: Taylor GI, Razaboni RM. eds. Arteries of the Muscles of the Extremities and the Trunk. St Louis: Quality Medical Publishing; 1994
- 13 Rees MJ, Taylor GI. A simplified lead oxide cadaver injection technique. Plast Reconstr Surg 1986; 77 (01) 141-145
- 14 Sheetz KK, Bishop AT, Berger RA. The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts. J Hand Surg Am 1995; 20 (06) 902-914
- 15 Sotereanos DG, McCarthy DM, Towers JD, Britton CA, Herndon JH. The pronator quadratus: a distinct forearm space?. J Hand Surg Am 1995; 20 (03) 496-499
- 16 Johnson RK, Shrewsbury MM. The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint. J Hand Surg Am 1976; 1 (03) 205-209
- 17 Basmajian JV, DeLuca CJ. Muscles alive-Their Functions Revealed by Electromyography. 5th ed.. Baltimore: Williams and Wilkins; 1985: 283
- 18 Sauerbier M, Berger RA, Fujita M, Hahn ME. Radioulnar convergence after distal ulna resection. Acta Orthop Scand 2003; 74 (04) 420-428
- 19 Brand PW, Beach RB, Thompson DE. Relative tension and potential excursion of muscles in the forearm and hand. J Hand Surg Am 1981; 6 (03) 209-219
- 20 Stuart PR. Pronator quadratus revisited. J Hand Surg [Br] 1996; 21 (06) 714-722
- 21 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67 (02) 177-187
- 22 Syed SA, Zahir KS, Zink JR, Saglaam O, Restifo RJ, Thomson JG. Distal dorsal forearm flap. Ann Plast Surg 1997; 38 (04) 396-403
- 23 Shibata M, Ogishyo N. Free flaps based on the anterior interosseous artery. Plast Reconstr Surg 1996; 97 (04) 746-755