Surg Radiol Anat (2007) 29:245–251 DOI 10.1007/s00276-007-0203-7 123 ORIGINAL ARTICLE The proximal radial artery perforator Xap (PRAP-Xap): an anatomical study for its use in elbow reconstruction Cesare Tiengo · Veronica Macchi · Andrea Porzionato · Carla Stecco · Anna Parenti · Franco Bassetto · RaVaele De Caro Received: 6 May 2006 / Accepted: 1 March 2007 / Published online: 29 March 2007  Springer-Verlag 2007 AbstractWe investigated the anatomical vascular basis of the proximal radial artery perforator Xap (PRAP-Xap) and we report here the Wrst clinical application in a case of recon- structive surgery as an alternative to traditional regional fas- ciocutaneous pedicled Xaps or microsurgery solutions. In 16 unembalmed cadaveric forearms, the radialartery was slowly injected with acrylic resin through the brachial artery and the superWcial Xexor compartment was dissected. The Xap was raised from the lateral and medial sides of the fore- arm toward the axis represented by the radial artery, and the characteristics (number, diameter, site and interval of origin, and course) of its collaterals were evaluated. In the proximal forearm, the vessels were less numerous (mean values 8.6 vs. 11.5, P < 0.05) but larger in diameter (mean values 0.7 vs. 0.4 mm, P < 0.05) than in the distal forearm. The Wrst four proximal perforator arteries originated within a mean dis- tance of 4.3 cm from the origin of the radial artery, with a 95% conWdence interval of 3.8–4.8 cm. The perforator arter- ies followed the axis of the forearm and anastomosed in the fascial plane, forminglongitudinal fan-shaped arterial chains, giving rise to an epifascial vascular network. This anatomical study allowed us to plan and perform a PRAP- Xap in a 35-year-old woman who was suVering from comm nuted fractures of the olecranon and distal epiphysis of th humerus and soft tissue loss from traumatic injury o elbow. From the antebrachial surface, a proximally b radial forearm fasciocutaneous Xap was raised, with a vas lar pedicle of 16 £ 5 cm, a cutaneous island of 4 £ 5 c and a pivot point 5 cm from the interepicondylar line. The Xap showed good immediate and long-term viability: it wa completely incorporated with good pliability and the patie regained good functional quality of the elbow joint. The an tomical features and the demonstrative reconstructive res obtained in the here-reported surgical case support the cl cal evidence that a reliable forearm skin paddle may raised on a subcutaneous fascial axial pedicle supplied on by proximal perforators of the radial artery. The so-obtain PRAP-Xap is useful for the coverage of elbow defects whe other reconstructive options are no longer available. KeywordsRadial artery · Perforator Xap · Anatomy · Elbow reconstruction · Plastic surgery Introduction Soft tissue defects of the elbow region are often di Ycult to repair. The functional importance of this region requi well-vascularized coverage. In the reconstructive program the surgeon must respect the characteristics of the soft ti sue of this functional district. The coverage of the do aspect of the elbow needs thin, pliable skin with a gliding surface, and reconstruction of the volar aspect must guar tee soft coverage with elastic subcutaneous tissue to prot nerves, arteries, tendons and the joint, to allow all degree of motion [ 4]. C. Tiengo · F. Bassetto Section of Plastic Surgery, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy V. Macchi · A. Porzionato · A. Parenti · R. De Caro (&) Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A Gabelli 65, 35127 Padova, Italy e-mail: rdecaro@unipd.it C. Stecco Orthopaedic and Traumatology Clinic, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy