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OBJECTIVE@#To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap.@*METHODS@#Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function.@*RESULTS@#All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good.@*CONCLUSION@#Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.
Subject(s)
Male , Humans , Female , Young Adult , Adult , Middle Aged , Perforator Flap , Fingers , Upper Extremity , Ulnar Artery , SkinABSTRACT
A patient who suffered soft tissue defects of all 5 digits of left hand was referred to the Department of Hand and Foot Surgery, Affiliated Nanhua Hospital, University of South China in January 2020. A quadruple paddled posterior interosseous artery flaps was used to cover the defect in index, middle, ring and little fingers and a free hallux nail flap was used to repair the defect in thumb. Two years after operation, the appearance and texture of the flaps of all digits in the left hand were good. The function of the digits was good as well. There were slightly noticeable scars left in both the donor sites of left forearm and right foot.
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Objective:To investigate the clinical effect of Flow-through perforator flap of posterior interosseous artery in repair of dorsal digital soft tissue defect with disorder of blood supply in digital tip.Methods:From January 2018 to June 2020, 12 patients who had digital dorsum soft tissue defect with digital tip blood supply disorder were treated with Flow-through perforator flap of posterior interosseous artery. The size of flaps was 2.0 cm× 2.0 cm-5.5 cm×3.0 cm. The posterior interosseous artery in the flap was bridged with the proper palmar artery of digit, 1 subcutaneous vein in the flap was anastomosed with the dorsal subcutaneous vein, and 1 subcutaneous vein in the posterior interosseous artery with the palmar subcutaneous vein. The donor sites were sutured directly. The wound healing, blood supply of digit and flap survival were observed after operation. The quality of flap survival and digital joint function were observed in the follow-up reviews at outpatient clinic.Results:All the 12 Flow-through perforator flaps of posterior interosseous artery survived, the blood supply of digit was good, and the wounds healed in the first stage. The follow-up period was 6-24 months. The appearance and texture of the flaps were good without obvious bloating. Only linear scar was left in the forearm donor site. According to the Trial Standard of Upper Limb Function Evaluation of Chinese Society of Hand Surgery, the results were excellent in 11 cases and good in 1 case.Conclusion:The perforator flap of posterior interosseous artery has constant anatomy, and the diameter of blood vessel matches the blood vessels of digits. It is suitable for Flow-through technique. It has less subcutaneous tissue, no secondary thinning, and the donor site can be closed directly. It is a good method to repair the dorsal soft tissue defect with disorder of digital end blood circulation.
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Objective:To investigate the preliminary clinical effect of posterior interosseous artery propeller flap in the repair of dorsal of wrist and hand wounds.Methods:From March, 2015 to December, 2019, 9 cases of dorsal of wrist and hand wounds were repaired with posterior interosseous artery propeller flap, including 6 cases of dorsal hand defect and 3 cases of dorsal wrist defect. Defect area: 6 cm × 4 cm-3 cm × 3 cm; There were 3 cases of metacarpal fracture, 1 case of phalangeal fracture and 1 case of tendon rupture. According to the size and shape of the wound, the posterior interosseous artery propeller flap was designed to transfer and repair the soft tissue defect wound. The size of the flap: 20 cm × 5 cm-12 cm × 3 cm, the size of posterior interosseous artery propeller flap was recorded and the surgical characteristics were summarized; The survival of the flap, donor and recipient complications were observed and followed-up.Results:All flaps were cut smoothly and the donor areas were sutured directly. The flap survived completely in 8 cases and partial necrosis in 1 case; One case complicated with wound infection. The follow-up ranged from 6 to 31 months, with an average of 14 months. The texture and shape of the flap were good; The last DASH score was 3-18, with an average of 9.3; There were 2 cases of mild scar hyperplasia in the donor area and 1 case of mild scar hyperplasia at the edge of the flap.Conclusion:Posterior interosseous artery propeller flap may be an effective method to repair small and medium-sized wounds of dorsal of wrist and hand.
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Background: The study of brachial artery is an important arterial conduit from the clinical point of view toanatomists, general surgeons, radiologists, plastic surgeons, and even cardiovascular thoracic surgeons in theconduct of reparative surgery.Therefore, the present study was designed to study the course, branching patternand termination of Brachial Artery and its clinical significance of these variations.Materials and Methods: The present study was conducted on 30 upperlimbs of 15 cadavers embalmed & belongingto theDepartment of Anatomy, Govt. Medical College,Alappuzha over the period of 1 year. By conventionaldissectionmethod a longitudinalincision was given along the midline of arm through the deep fascia, inferiorupto cubital fossa. Brachial artery was identified, cleaned & dissected and assessed the length of brachial artery,level of termination of brachial artery, variation in the branching pattern and the course in relation to themedian nerve was noted.Results: The average length of the brachial artery was 25.23 cms. 73.3% of the brachial artery followed theclassical pattern as given in Gray’s Anatomy. Variation in the branching pattern, presence of accessory brachialartery, origin of profunda brachial artery was noted. 3.3% trifurcation of brachial artery into Radial, Ulnar &Common interosseous at the level of neck of radius.Brachial artery terminated at the level of neck of radius in76.67%, radial tuberosity13.33%, mid arm3.33%, proximal arm 6.67%.Discussion and Conclusion: Variationsof brachial artery in its relationship with the median nerve, pattern andlevel of termination are common. These may complicate arm surgical exposure, flap and vascular surgery.Hence, Knowledge of possible variations in the branching pattern of various arteries is important during vascularand reconstructive surgery.
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Background: The nutrient foramen of Human ulna bone is on the anterior surface of shaft of ulna almost proximalto the mid point and is directed upwards. Nutrient foramen permits the passage of the branch of anteriorinterosseous artery.Methods: The present study was conducted on 70 dry human ulna bones of unknown sex and age obtained fromGovernment Medical College Jammu. The Ulna bones were observed macroscopically for nutrient foramen.Results: In our study we observed that only 2 bones were without nutrient foramen and two of the bones with twonutrient foramen on right side while one foramen on all the left side. The location of nutrient foramen in right andleft ulna bones was 72% in the middle one third, 18% in upper third and 8% at the junction of upper and middleone third. The position of nutrient foramen was 80% on the anterior surface, 11% on the Interosseous border and7% on the anterior border. All the foramen were directed upwardsConclusion: The study of nutrient foramen is of utmost importance to the forensic experts as in determining thelength of ulna and to the orthopaedicians for deciding different treatment modalities in case of fractures of shaftof ulna so as to prevent non-union or avascular necrosis and also helpful for highly specialised surgicalprocedures like vascularised bone grafting involving microsurgery
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Objective To explore the clinical curative effect for wound surface of hand heatcompression injury treated by improved posrerior interosseous artery reversed island flap.Methods Between January,2010 and September,2015,20 patients were treated for wound surface of hand heatcompression injury.Of 20 cases,there were 16 males and 4 females,aged 18-45 years (mean,32 years);and the left hand was involved in 9 cases and the right hand in 11 cases.Two-stage repair was performed in 20 cases after emergency admission.The locations of heatcompression injury were dorsal hands in 12 cases,first webs in 6 cases,and dorsal thumb in 2 cases.The wound area of hand heatcompression injury were 4.0 cm×5.0 cm-6.0 cm×8.0 cm,which were all repaired by improved interosseous dorsal artery retrograde island flap whose area were 3.5 cm ×4.5 cm-7.0 cm×8.0 cm.One week after operation,fingers and thumb-index web began to promote rehabilitation functional training in the protection of orthosis.All patients were followed-up at regular intervals.Results All postoperative flap and the grafted skin at donor sites survived.Twenty patients were followed-up for 3-12 months (mean,6.5 months).The flaps had satisfactory appearance and soft texture.The thumb web widing and flexion and extension of the fingers were fine.According to Trial Standard Evaluation of the Upper-Limb Part Function of the Hand Surgery Association of the Chinese Medical Association,the results were excellent in 12 cases,good in 6 cases,and fair in 2 cases at 3 months after operation.Conclusion To repair wound surface of hand heatcompression injury by improved posterior interosseous artery reversed island flap is a fairly ideal operative approach.The type of operations is simple in operation,has high survival rate of postoperative skin flap.
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Introduction: The brachial artery starts at the inferior border of teres major and ends by dividing into ulnar and radial arteries in cubital fossa region. The radial artery frequently arises at the level of the neck of the radius and runs along the lateral side of the forearm. Case report: During routine teaching for undergraduate medical student of the upper limb, atypical brachial artery bifurcation giving a high origin of the radial and ulnar arteries was found in the right upper limb of a male cadaver. The bifurcation level was proximal to the interchonylayar line. After that, the ulnar artery descends and gives prominent common interosseous artery at the neck of radius. Conclusion: This case report of vascular variability of the upper limb is to alert vascular radiologists and surgeons as well as nephrologist to prepare a modified surgical intervention of arteriovenous fistula in renal haemodialysis. There is always great vascular variability of the upper limb therefore it is important to be aware of anatomical variation and to avoid iatrogenic fault.
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Variations in course of the arteries are well documented. Knowledge of the variation of the arterial system is important during vascular and reconstructive surgeries, in the evaluation of angiographic images. During routine anatomical dissection of upper limb ,of adult male cadaver of 55 years in Department of anatomy, SNMC, Agra, we came across a variant origin of the ulnar artery, instead of terminal division of brachial artery it arose from the brachial artery at its lower 1/3 part ,also it followed a superficial course. Brachial artery in the cubital fossa divided into radial artery and common interosseous artery, also the anterior and posterior ulnar recurrent branches arose from the common interosseous branch instead of ulnar artery. Knowledge of this variation is important for anatomist, embryologist, radiologists keep pace with new emerging variations, also for orthopaedicians, surgeons for planning appropriately operative procedures involving this region.
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Objective To discuss the reason of skin flap necrosis caused by vascular crisis of reverse island flap of forearm posterior interosseous artery.Methods Eight-six patients who were underwent reverse island flap of forearm interosseous posterior artery for deep tissues and skin defect on the back of hand between March,2002 and April,2014 were analyzed in this study.Eleven patients had occurred skin flap necrosis,include 5 cases had completely flap necrosis caused by circulation crisis,and 6 cases had partial necrosis at the distal of the flap.Among the necrosis cases,5 cases were injured by the machine injury,4 cases by the heavy crush and 2 cases by the traffic accident.The cause of circulation crisis was analyzed.Results In the series,75 skin flaps survived completely and 11 cases had occurred necrosis,included completely necrosis with 5 cases.The reasons of flap crisis were as follows:for the completely necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with absence of posterior interosseous artery,1 case with vessel pedicel entrapment in subcutaneous tunnel,and 1 case with misconduct venous congestion caused by the reverse perfusion of superficial vein.The reason of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 3 of them with distortion of entrapment at pedicel and vein crisis.One case was cured through debridement,change of medical prescription and skin grafting;and 4 cases were cured with other flap repair technique.For the partial necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with excessively narrow entrapment at pedicel in subcutaneous tunnel,1 case with folding vessel pedicel entrapment of skin at the back of wrist,1 case with misconduct of superficial vein trunk and 1 case with intraoperative side-injury.The symptoms of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 4 of them with distortion of entrapment at pedicel and vein crisis.Four cases were cured through debridement and skin grafting,1 case was cured by the vacuum-sealing drainage (VSD) and 1 case with skin flap repair at pedicle of abdomen.Conclusion The anatomic variation of perforator vessel of reverse island flap of forearm posterior interosseous artery;narrow entrapment at pedicel in subcutaneous tunnel and distortion of entrapment at pedicel;venous congestion caused by the reverse perfusion of superficial vein;intraoperative side-injury of the pedicel of the flap;excessively folding vessel pedicel entrapment of skin at the back of wrist after surgery will cause the circulation crisis of reverse island flap of forearm posterior interosseous artery and induce the necrosis of the skin flap.
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Background: The Brachial Artery ,usually a continuation of the axillary artery begins at the distal border of teres major and ends about a centimetre distal to the elbow joint by dividing into the radial and ulnar artery. Objectives: A. To document the origin of anterior interosseous artery from brachial artery. B. To establish embryological and clinico-anatomical correlation of such variations. Methods: These findings were observed after meticulous dissection of the upper limbs of both sides of a 43 year old adult male cadaver in the department of anatomy ,R .G .Kar Medical College ,Kolkata. Results: The brachial artery present in the right limb gave a branch in the upper 1/3 of the arm from its lateral aspect. This branch of brachial artery went downwards and became deep to pronator teres and continued as the anterior interosseous artery. The brachial artery itself descended and remained superficial to pronator teres. Just below the elbow joint it underwent bifurcation into radial and ulnar artery.The subsequent course of those two arteries was normal. And there was absence of common interosseous artery. So the anterior interosseous artery instead of arising from the common interosseous artery which was the branch of the ulnar artery took origin from brachial artery. Conclusion: This variation was explained in the light of embryological development and such variations were useful for physicians, surgeons, nephrologists ,radiologists and interventionist in various surgical procedures and also for diagnostic and therapeutic approaches.
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After arising from the brachial artery in the cubital fossa the ulnar artery usually passes deep into the superficial flexor muscles of the forearm. In the lower two-thirds, it typically follows a sub-fascial course. In the present case, during a routine undergraduate course dissection of a cadaver, it was found that the ulnar artery arose normally as a terminal branch of the brachial artery in the cubital fossa, followed a sub-fascial course by lying superficial to the flexor muscles then completed the superficial palmar arch in hand. This artery gave only minute muscular branches in the forearm. Moreover, the main branches that usually arise from the ulnar artery were given off by the radial artery. This type of variation is of importance for both the clinicians and surgeons due to its vulnerability to injuries and of academic interest for anatomists.
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Introduction: Persistent median artery originates from the anterior interosseous artery in proximal one-third of the forearm and accompanies median nerve. Median artery may regress in the forearm or enter palm through the carpal tunnel deep to flexor retinaculum of wrist and supply palm by anastomosing with the superficial palmar arch. Objective: In present study the objective was to study presence of persistent median artery accompanying median nerve and its termination Materials and Methods: The study included 50 human cadaver upper limb specimens at the Department of Anatomy, Mysore Medical College & Research Institute, Mysore during 2011-13. These specimens fixed in 10% formalin were finely dissected and persistent median artery was traced from origin to termination. Results: Out of 50 human cadaver specimens, persistent median artery was present in 4 specimens (8%). All the 4 median arteries originated from anterior interosseous artery and were of palmar type which reached palm. Out of 4 median arteries, 3 median arteries (6%) took part in completion of superficial palmar arch, supplying the distal aspect of palm and 1 median artery (2%) directly supplied radial two and half fingers without forming arch. Conclusion: Knowledge of unusual variations helps in proper treatment of disorders of the median nerve. Presence of persistent median artery usually will be asymptomatic but may cause symptoms of carpal tunnel syndrome or pronator teres syndrome when subjected to compression. Rarely this artery can be taken for reconstruction.
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Objective To summarize the method of forearm skin flap with dorsal interosseous artery placed by turning the proximal end of the flap to the distal side of the wound to repair skin and soft tissue defect of palm and thumb of hand,and put forward the key points of operation.Methods From 2008 to 2013,the forearm skin flap with interosseous dorsal artery to repair skin and soft tissue defect of palm and the part between thumb and index finger in 20 cases.Dorsal interosseous artery in the forearm is passing through between superficial and deep layers of extensor muscles and sends out 5-13 cutaneous branches to dorsal antebrachium skin.The large skin flap has good blood supply with high survival rate.Results All flaps survived,and good results were achieved in all 20 cases.Conclusion The flap preserved two main arteries from upper limb with good blood supply,and the amount of blood supply of the flap depended on the size of flap,and the wound of donor site can be directly sutured up or covered with free skin graft,thus minimizing the alteration of appearance and function of donor area.
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A variant course and branching pattern of the right brachial artery was recorded in a 54-year-old male cadaver during the practical sessions of University College of Medical Sciences, Delhi, India. The right brachial artery divided in the middle third of arm into a medial superficial and lateral deep branch. The superficial medial branch descended anterior to the median nerve and ended by dividing in the cubital fossa into ulnar and radial arteries, whereas the lateral branch descended postero-medial to the median nerve, ending deep to pronator teres as the common interosseous artery. The left brachial artery showed a normal branching pattern by dividing into radial and ulnar arteries in the cubital fossa. The probable origin of such a variation is embryological and familiarity with such variations is imperative as they might affect dynamics of limb function or alter the course of interventional procedures.
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Objective To discuss the method and treatment outcome of vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap.Methods Eight cases with vascular variation were adjusted flap position,two cases were repaired by single perforator flap,three cases were repaired by cutting perforator and anastomosing perforator after changing the path,three cases were repaired by designing composition leaves flap.Results Seven flaps survived,one flap partly necrosis and healed by skin-grafting,and all of the patients were followed-up 3 to 18 months.The color,texture and thickness of the flaps were satisfactory.The movements of the fingers were satisfactory.According to the hand function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,outcomes were rated excellent in 1 case,good in 5 cases,fair in 2 cases.The excellent and good rate was 75％.Conclusion When finding vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap,adjust flap position,repair by single perforator flap,cutting perforator and anastomosing perforator after changing the path,or designing composition leaves flap is a good treatment option.
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Objective To provide anatomical landmarks with which to facilitate flap dissection,we studied the perforator artery of the dorsal forearm including its source,quantity,origination,caliber,variation and pedicle length. Methods Ten fresh cadavers were injected with a modified lead oxide-gelatin mixture,and three-dimensional graphics of the perforator vessels of the dorsal forearm were reconstructed with a computed tomography. In addition, twenty upper extremity specimens were injected with red latex via the axillary artery.The integument of the forearm was dissected,and perforators were identified,including type,course,size and location were documented.Surface areas were measured with Scion Image. Results The average number of the posterior interosseous artery cutaneous perforators in the dorsal forearm was (5±2),the average outer diameter of the perforator artories was (0.5 ± 0.1) mm,and the pedicle length was (2.5 ±0.2) cm.The average cutaneous vascular territory was (22.0 ± 15.0) cm2.The dorsal branch of the anterior interosseous artery dispersed on the wrist dorsum or the distal third of the dorsal forearm. It's average diameter was 0.8 mum. Conclusion The free transplantation of the posterior interosseous perforator artery flaps or rotary flap pedicled by the dorsal branch of the anterior interosseous artery for defect reconstruction are feasible.
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Objective To present the therapeutic effect of the free bilobed posterior interosseous flap for soft tissue reconstruction of two fingers.Methods According to the distance between the defects of two adjacent fingers,combining the cutaneous branches of different regin,the free bilobed flaps pedicded with posterior interosseous artery were applied for soft tissue reconstruction of 20 fingers in 10 patients.The defects of digits was on thumb and index( 1 case),index and middle(2 cases),middle and ring(4 cases),ring and little (3 cases).The size of defect was ranged from 2.5 cm × 2.0 cm to 9.5 cm × 3.0 cm.The size of single flap was from 3.0 cm × 2.5 cm to 10.0 cm × 3.5 cm.Results The flaps on 19 fingers were completely survived and the flap on 1 finger had the pointed end necrosis which healed by dressing changing.After 6 to 22 months (the average was 13.8 months ) followed-up visit,all flaps were with excellent colour and texture.The flaps in 8 cases were thin and the flap in 2 case was a little thick.Eight single flaps in which the cutaneous nerve was sutured recovered 2-PD of 10 to 15 mm (the average was 12.8 mm).There was no affection in motor function on donor site of all cases.Conclusion The free bilobed posterior interosseous flap is the valuable option for two fingers soft tissue reconstruction and it can achieve the cosmetically and fuctionaly acceptable result with low morbidity on donor site.
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ObjectiveTo provide anatomy information for harvesting a pedicle or free posterior interosseous artery cutaneous branches-chain flaps. MethodsFourteen forearms from fresh human cadaver were used to study the anatomy characteristics of the posterior interosseous artery cutaneous branches-chain flaps with the following three methods:latex perfusion for microanatomy,denture materials and vinyl chloride mixed packing for cast,and PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography.The cutaneous perforator with a diameter ≥ 0.2 mm were included for statistical analysis.Results① There were 6.2 cutaneous branches raised from posterior interosseous artery. Measuring from the radial edge of ulnar head to the lateral epicondyle of humerus as the standard distance, the distal cutaneous branch clusters located at 21.24％ relative to the standard distance,while the proximal clusters located at 47.86％.② There were two large cutaneous perforators from the posterior interosseous artery at(5.82 ± 1.22)cm proximal to the ulnar styloid and (10.34 ±0.98)cm distal to the epicondyle of humerus.The diameter and pedicle length of the distal perforators were(0.50± 0.04)mm and (16.79 ± 5.12)mm respectively,while the proximal perforator were (0.60 ± 0.08 )mm in diameter with a pedicle (21.20 ± 12.28)mm in length.③ The vascular chains parallel to the posterior interosseous artery were formed via anastomosis of the adjacent cutaneous perforators. ConclusionThere is clinical significance to use pedicle or free posterior interosseous artery cutaneous branches-chain flaps.
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A detailed description of the vascular pattern of upper limbs especially their variations in their origin, course and branching pattern is of utmost importance anatomically in general and clinically in particular. These variations have drawn attention of surgeons, physicians, radiologists and interventionists due to the advanced surgical procedures practiced in vascular surgeries, plastic (reconstructive) surgeries and also for diagnostic and therapeutic approaches. 50 cadavers (100 upper limbs) were used for the study, which were dissected as the part of routine dissection for teaching undergraduate students at our institution. Length of the normal and variant arteries with mean, standard deviation, 'p' and 't' values are noted in each of the limbs. The following variations are observed: i) high division of brachial artery, ii) higher origin of profunda brachii artery, iii) high origin of radial artery, iv) absence of common interosseous artery. The variations are of particular importance to the surgeons operating in the area, especially for those involved in vascular reconstructive surgeries. So it is prudent to do pre-operative studies of the brachial and antebrachial arteries and their branching patterns, to prevent possible complications post operatively.
Una descripción detallada del patrón vascular de los miembros superiores, especialmente sus variaciones en el origen, curso y patrón de ramificación son de suma importancia anatómica en general y clínica en particular. Estas variaciones han llamado la atención de los cirujanos, médicos, radiólogos e intervencionistas debido a los procedimientos quirúrgicos avanzados practicados en cirugía vascular, cirugía plástica (de reconstrucción) y también para los métodos diagnósticos y terapéuticos. 50 cadáveres (100 miembros superiores) se utilizaron para el estudio, los que fueron disecados como parte de una disección de rutina para la enseñanza de los estudiantes de pregrado en nuestra institución. La longitud de las arterias normales y variantes con su media, desviación estándar, valores "p" y "t" se observaron en cada uno de los miembros. Las siguientes variaciones se observaron: i) división alta de la arteria braquial, ii) origen alto de la arteria braquial profunda, iii) origen alto de la arteria radial, iv) ausencia de la arteria interósea común. Las variaciones son de particular importancia para los cirujanos que operan en la zona, especialmente para quienes participan en cirugías de reconstrucción vascular. Por lo tanto, es prudente hacer estudios pre-operatorios de las arterias braquial y antebraquiales y sus patrones de ramificación, para evitar posibles complicaciones post-operatorias.