Dorsal branches of superficial radial nerve: an anatomic study with potential clinical applications

Abstract

An anatomical study was performed to assess the course of the dorsal branches of superficial radial nerve and to investigate potential clinical applications in hand surgery. Eight upper extremities were dissected, using an operating microscope. All branching points of the superficial radial nerve were noted and the distances from the radial styloid process were recorded. Their proximity to neighboring vascular structures was noted. The superficial branches of the radial nerve can vascularize axial neurofasciocutaneous flaps via their paraneural arterial network. In addition, various reverse neurofasciocutaneous flaps may be harvested, based on dorsal branches of the superficial radial nerve. The nerve can be anastomosed with a suitable nerve in the recipient area. The dorsal branches of the superficial radial nerve can easily be added to the reverse first dorsal metacarpal artery flap and other reverse dorsal metacarpal artery flaps, thus making it possible to form a sensate flap. These branches may be anastomosed with nerves in the recipient site, such as dorsal branches of digital nerve stump, without significant donor site morbidity. A free sensate first dorsal artery flap can be prepared with a combination of dorsal branches of the superficial radial nerve and used with the same indications as a free digital artery flap. It has some advantages over the free digital artery flap, because the main neurovascular structures of the finger are kept intact. Finally, a dorsal nerve branch which accompanies the first dorsal metacarpal artery may be harvested with this artery and a subcutaneous dorsal vein as vascularized nerve graft. It can be used to repair a digital nerve defect in dense scar tissue.