Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Introduction  Vascularized periosteal flaps (VPFs) have proven to be a useful technique for the treatment of unfavorable biological situations in children, with excellent results due to their osteogenic potential. The objective of this work is to present a detailed anatomical description of the periosteal vascularization of the radius and ulna, as well as the design of the forearm VPFs. Methods  Anatomical study with 10 fresh-frozen specimens with antegrade injection of green colored latex. Periosteal branches of the radius and ulna, septocutaneous branches, and muscular branches were dissected. The size of the pre and postdissection flaps was measured, as well as the length of the vascular pedicles. Results  The four vascular axes studied were the anterior interosseous vascular axis (AIA), radial axis (RA), ulnar axis (UA), and posterior interosseous vascular axis (PIA). The AIA (volar-radial VPF): an average of 16.2 periosteal branches were obtained, with a mean distance of 6.6 mm between them. The mean size of the VPF was 41.3 cm 2 pre-dissection and 32.4 cm 2 post-dissection. The average pedicle length was 16.1 cm. Vascular RA (radial VPF) : an average of 20.8 branches was found, with a mean VPF size of 54.8 cm 2 predissection, and 39.3 cm 2 post-dissection. The average pedicle length was 20.2 cm. Vascular PIA (dorsal-ulnar VPF): an average of 12.8 periosteal branches were obtained, with the mean VPF size being 26.2 cm 2 pre-dissection and 20.4 cm 2 post-dissection. The average pedicle length 12.6 cm. Vascular UA (ulnar VPF): an average of 10.2 periosteal branches were obtained with a mean VPF size of 37.5 cm 2 pre-dissection and 28.2 cm 2 post-dissection. of the average pedicle length was 14.8 cm. Conclusions  We have described four new VPFs, with the most useful and versatile being the dorsal-ulnar VPF, based on the PIA, and the volar-radial, based on the AIA. The main advantages of these flaps with respect to microsurgical techniques are the simplicity and speed of the technique, its elasticity and adaptability to the recipient bed, as well as its versatility.