Bilateral absence of the deep brachial artery.

The aim of the following study was to present and comprehensively describe a case of a bilateral absence of the deep brachial artery (DBA). Furthermore, its embryology and clinical significance will also be discussed. During routine dissection, a 71-year-old male cadaver with a bilateral abnormality in the DBA and its branches was found. The first branch of the brachial artery (BA) was found to be the radial collateral artery, which passed behind the radial nerve. Furthermore, the middle collateral artery originated distal to the radial collateral artery and gave off first a singular, minor muscular branch and then the superior ulnar collateral artery. Later, the preceding nutrient arteries of the humerus and the deltoid branch consecutively branched off from the middle collateral artery. Subsequently, the middle ulnar collateral artery, the inferior ulnar collateral artery, the deltoid artery, the radial artery, and the ulnar artery branched off from the BA, as adapted in the current knowledge regarding the anatomy of the upper extremity. Furthermore, detailed measurements of the distances between the mentioned arteries were carried out. In the present study, a bilateral absence of the DBA was demonstrated. Meta-analysis focusing on the anatomy of this artery has shown how variable its characteristics are. However, our case report is the first in the literature to present this extremely rare variation. Having adequate knowledge regarding the anatomy of the arteries of the proximal arm is of immense importance when performing orthopaedic and reconstructive surgeries in this area.

The Unusual High Origin Radial Artery in a Black Kenyan Population: A Cadaveric Study.

Background: The anatomy of the radial artery draws great interests among anatomists for its frequent involvement in variations. Equally, these variations have gained significant attention from clinicians because of the preference to use the radial artery for catheterization. The commonest of radial artery variations involve its site of origin. In published literature, data on this variations exist, but the prevalence of such variations in a Kenyan population has hitherto been unknown. Methods: Sixty-two upper limbs from 50 formalin-fixed cadavers were studied during dissection in the Department of Human Anatomy, University of Nairobi. Results: Fifty-four (87.1%) radial arteries arose within the cubital fossa, while eight (12.9%) had a high origin. Out of the eight high arteries, two (3.2%) branched off from the axillary artery, another two (3.2%) were branches of the proximal third of the brachial artery and four (6.5%) arose from the middle third of the brachial artery. The high origin radial arteries were more common on the right upper limbs (5 out of the 8 cases). Both axillary and brachial origins were seen bilaterally. Conclusion: The present study details important variations in the anatomy of the radial artery in a Kenyan population. With the radial artery being utilized during clinical, surgical and radiological interventions so frequently, an increased understanding and anticipation of such topographic variances is paramount.

Anatomical variations of the superficial ulnar artery: case series observed on historical specimens prepared by Ludwik Karol Teichmann.

BACKGROUND: This report presents a series of cases representing variant origin and course of the ulnar artery, namely the superficial ulnar artery (SUA), observed during the review of collection of historical specimens prepared in the 19th century by the prominent Polish anatomist Ludwik Karol Teichmann and his collaborators, exhibited in the Anatomy Museum of Jagiellonian University Medical College. RESULTS: Three distinct variants of the SUA were found on anatomical specimens of the upper limb with arteries injected by using Teichmann's method. In case no. 1, the SUA originated from the brachial artery slightly above the interepicondylar line of the humerus. This aberrant vessel gave off the common interosseous artery in the upper half of the cubital fossa and then ran superficially to the bicipital aponeurosis and over the muscles arising from the medial epicondyle of the humerus. The cases no. 2 and 3 involved two similar variants of the superficial artery in which the common interosseous artery arose from the radial artery. In the unique case no. 4, the SUA arose from the radial artery. CONCLUSIONS: The SUA shows diverse anatomy regarding its topography and blood supply territory. Orthopaedic, hand, and plastic surgeons should be aware of anatomic variations of the SUA both in planning and in conducting surgeries of the upper limb.

Is there an athlete's artery? A comparison of brachial and femoral artery structure and function in male strength, power and endurance athletes.

OBJECTIVES: Exercise places physiological demands upon the cardiovascular system, subsequently leading to adaptations in structure and function. Different exercise modalities (endurance, strength and power) lead to distinct hemodynamic demands and, possibly, different patterns of adaptation. Our aim was to assess and compare brachial and femoral artery function and structure in elite level athletes engaged in endurance, strength and power sports. DESIGN: cross sectional comparison. METHODS: 30 male elite athletes (runners n=10, powerlifters n=11, weightlifters n=9) and 23 healthy controls were recruited. Brachial and femoral arterial diameters were assessed using ultrasound. Arterial function (brachial and femoral arteries) was determined using the flow mediated dilation (FMD) technique and body composition using body mass index (BMI) and body surface area (BSA). RESULTS: Weightlifters had significantly larger brachial arterial diameters compared to controls (4.39±0.34 vs 3.86±0.42mm, p<0.01). As weightlifter and power athletes had significantly higher body mass, BMI and BSA, we adjusted diameter for BSA. BSA-correction ameliorated differences in brachial artery resting diameters between athletes and controls. However, BSA-corrected femoral artery diameter was significantly larger in runners compared to controls (3.51±0.28 vs 3.25±0.34mm, p<0.05). There were no differences in brachial FMD between groups. Femoral artery FMD was significantly higher in runners and weightlifters compared to controls (p<0.05 for both groups). CONCLUSIONS: Heterogeneous, limb-specific structural and functional vascular adaptation is evident in athletes, which may be influenced by exercise modality. Further, vascular remodelling relates to differences in body shape, specifically body composition, which should be accounted for when comparing athletes.

A macroscopic comparison study on main branches of arteria brachialis and arteria subscapularis in Southern Karaman and Hasak sheep breeds.

BACKGROUND: The Southern Karaman sheep, which is very fertile in terms of meat and milk production and is often preferred in livestock raising, is known as a domestic sheep breed. The Hasak sheep is a breed formed by the triple crossbreeding of the German Black-headed, Hampshire and Akkaraman breeds. Arterial feeding of the forelimb is provided by arteria axillaris, a continuation of arteria subclavia. In this study, it was aimed to examine the forelimb arteries in Southern Karaman and Hasak sheep breeds. MATERIALS AND METHODS: Totally, 8 Southern Karaman and 8 Hasak sheep were obtained from Konya Bahri Dagdas International Agricultural Institute. The sheep were anesthetised with xylazine and ketamine and extravasated by cutting the arteria carotis communis in the neck area of the sheep. The forelimbs of the sheep separated from the body were fixed in 10% formaldehyde solution and then dissections were made and the course and branching of the arteries were examined. RESULTS: It was determined that the arteria brachialis was divided into two main branches as distal arteria brachialis and proximal arteria subscapularis at the articulatio humeri level of the arteria axillary. Arteria mediana, which is a continuation of arteria brachialis, was also examined in different parts of antebrachium and ended by splitting into branches. CONCLUSIONS: According to the findings of the Southern Karaman and Hasak sheep breeds, it was determined that the forelimb arteries had some anatomical differences but were similar in structure to many sheep breeds.

Multiple arterial variations in the upper limb: description and clinical relevance.

Although arterial variations in the upper limb are usually found during anatomical dissections and clinical practice, multiple arterial variations associated with nervous variations along the limb is rare and clinically relevant. This paper described a combined anatomical variation involving the neurovasculature in the upper limb. A left upper limb dissection of a male cadaver with approximately 50-60 years of age, fixed in 10% formalin, was performed. During the dissection was observed, the brachial artery ending in the middle third of the arm in three branches: a nutritional branch for the biceps brachii muscle, a "lateral brachial artery" and a "medial brachial artery", which became, after unusual paths crossing over the cubital fossa, the ulnar artery and the radial artery, respectively. Radial and ulnar artery demonstrated several unusual anastomotic branches, respectively, and an anastomotic arch around the biceps brachii muscle tendon. Such combined anatomical variation is unique and relevant for clinical and surgical practice.

Neurovascular axillary variations: superficial brachial artery and single-corded brachial plexus.

Variants of the axillary artery and brachial plexus were found bilaterally in the axilla of an 86-year-old Asian female. On the left, the cadaver donor had a high bifurcation of the second part of the axillary artery, creating a superficial brachial artery. Meanwhile, the right axilla presented with root, trunk, and cord variations in the formation of the brachial plexus, the most interesting feature being a single, unified cord. Presented in this case report are the structural relationships of the variants with considerations regarding anatomy, embryology, prevalence, and clinical importance.

Impact of preoperative arterial and venous diameter on achievement of the adequate blood flow in arteriovenous fistula for hemodialysis.

An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P = 0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation.

Upper limb arterial pattern: clinical correlation and embryological perspective / Padrão arterial dos membros superiores: correlação clínica com perspectiva embriológica

Abstract Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon's armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Resumo Contexto As variações no padrão arterial dos membros superiores são comuns e, assim, necessitam de total familiaridade para que os procedimentos cirúrgicos e de intervenção sejam bem-sucedidos. A variância na árvore vascular pode envolver qualquer parte da artéria axial dos membros superiores, incluindo a artéria axilar, a artéria braquial ou os seus ramos, na forma das artérias radial e ulnar, as quais, em algum momento, suprem as mãos através dos arcos anastomosados. Objetivos Avaliar as peculiaridades do padrão arterial dos membros superiores e correlacioná-las ao desenvolvimento embriológico. Métodos Foram examinados os ramos arteriais completos de 42 membros superiores de cadáveres adultos conservados em formalina, os quais eram rotineiramente dissecados para fins educacionais durante 3 anos no Departamento de Anatomia Lady Hardinge Medical College, Nova Delhi. Resultados O estudo apresentou cinco desfechos. 1. Foi constatado um caso em que um tronco comum surgiu da terceira parte da artéria axilar que imediatamente se disseminou em quatro ramos (2,4%). 2. Houve divisão maior da artéria braquial em artérias ulnar e radial em três casos (7,1%). 3. Em um caso, ocorreu pentafurcação da artéria braquial em ulnar, interóssea, radial, radial recorrente e de um galho muscular em braquiorradial (2,4%). 4. Foi constatado arco palmar superficial incompleto em três dos 42 casos (7,1%). 5. Foi observada a presença da artéria mediana em 2 dos 42 casos (4,8%). Conclusões Este estudo compreende o padrão arterial do membro superior e identifica os diversos padrões anômalos para agregar ao arsenal terapêutico de cirurgiões para diversos procedimentos cirúrgicos, com o objetivo de combater quaisquer complicações ou falhas de cirurgias reconstrutivas, de angiografias de cirurgias de revascularização e muitas outras.

Coexistence of variant pronator teres muscle and variant course of the neurovascular structures in the arm: clinical significance.

In literature, the presence of the supracondylar process, fibrous band enclosing the neurovascular structures, and the additional head of pronator teres have been reported as isolated reports. In this article, we describe three unique variations observed in the left upper limb of a 63-year-old female cadaver, (1) the variant origin of pronator teres from the supracondylar process, (2) the variant course of the median nerve and brachial artery passing through a fibrous tunnel in the lower third of the arm, later behind the supracondylar process and the variant pronator teres, and (3) the higher origin of radial artery from the brachial artery in the arm. The knowledge of such rare variants could be resourceful for surgeons in localizing the median nerve entrapment, interpreting arteriograms of the upper limb and avoiding accidental damage to the radial artery.

Anatomical study of the anterior neurovascular interval approach to the elbow: observation of the neurovascular interval and relevant branches.

BACKGROUND: The aim of the study was to investigate the anatomy of the anterior nerve and artery of the elbow joint to provide reference on the relevant surgical approach to the elbow joint, and determine a simple better surgical approach for the treatment of part of the fractures of the elbow joint. MATERIALS AND METHODS: The upper extremities of 10 adult cadavers fixed by formaldehyde and perfused with red latex in the artery were observed to investigate the anatomic structure of the anterior approach to the elbow joint. From the clearance of the brachioradialis and pronator teres muscle to the approach of the neurovascular interval, we observed the states of the median nerve, the brachial, radial and ulnar arteries, and its branches through anatomical layers and measurement methods. RESULTS: Through the anterior neurovascular interval approach to the elbow, nerve and artery can be protected, and the anterior structures of the elbow, such as the ulna coronoid process, humeroulnar joint and trochlea of the humerus, can be exposed. CONCLUSIONS: This study demonstrates that the anterior anatomical structure of the elbow joint including the trochlea of the humerus, coronoid process of the ulna and the front capsule of the elbow can be exposed through the anterior neurovascular approach to the elbow.

Physical Activity in Pregnancy Is Associated with Increased Flow-mediated Dilation.

PURPOSE: To determine the role of moderate-to-vigorous physical activity (MVPA) and sedentary behavior in flow-mediated dilation (FMD) and glucose metabolism during late pregnancy. METHODS: Seventy normotensive, euglycemic pregnant women (31.6 ± 2.9 yr) in their third trimester (28-39 wk) were recruited. After a fasted blood sample; FMD was measured (brachial artery Doppler ultrasonography, normalized for the shear stimulus [area under the curve]). Anterograde and retrograde shear rate were estimated. Physical activity (MVPA) and sedentary behavior were assessed via accelerometry for seven consecutive days (Actigraph wGT3X-BT). We categorized the women as active (>150 min·wk) or inactive (<150 min·wk) according to their accelerometry data. Data were corrected for age and gestational age. RESULTS: On average, women were sedentary 67.1% ± 8.2% of their waking hours. Active pregnant women (>150 min·wk MVPA, n = 32) engaged in 266.7 ± 99.3 min·wk MVPA, whereas inactive pregnant women (<150 min·wk MVPA, n = 38) engaged in 76.1 ± 42.5 min·wk MVPA. The FMD response (normalized to the magnitude of shear stress stimulus) was greater in active compared with inactive pregnant women (6.5 ± 4.4 a.u. vs 3.9 ± 3.5 a.u.; F = 4.619; P = 0.005). The MVPA in active pregnant women was inversely correlated with insulin concentrations (r = -0.556; P = 0.03). In inactive pregnant women, higher amounts of sedentary behavior were associated with lower amounts of retrograde shear rate (r = 0.504; P = 0.02), retrograde blood flow (r = 0.499; P = 0.02), and retrograde velocity (r = 0.508; P = 0.02) during baseline, but not correlated with the FMD response. CONCLUSIONS: Engaging in MVPA during pregnancy is associated with improved FMD and a lower insulin concentration. Sedentary behavior was not associated with FMD responses.

Variations in Blood Supply From Proximal to Distal in the Ulnar Collateral Ligament of the Elbow: A Qualitative Descriptive Cadaveric Study.

BACKGROUND: The vascular supply of the ulnar collateral ligament (UCL) is unknown. Previous studies reported varying success in return-to-play rates after nonoperative management of partial UCL tears and suggested a varying healing capacity as possibly related to the location of the UCL injury. PURPOSE: To analyze the macroscopic vascular anatomy of the UCL of the elbow. STUDY DESIGN: Descriptive laboratory study. METHODS: Eighteen fresh-frozen male cadaveric elbows from 9 donors were sharply dissected 15 cm proximal to the medial epicondyle. Sixty milliliters of India ink was injected through the brachial artery of each elbow. Arms were then frozen at -10°C, radial side down, in 15° to 20° of elbow flexion. A band saw was used to section the frozen elbows into 5-mm coronal or sagittal sections. Sections were cleared for visualization with the modified Spalteholz technique. Images of the specimens were taken, and qualitative description of UCL vascularity was undertaken. RESULTS: The authors consistently found a dense blood supply to the proximal UCL, while the distal UCL was hypovascular. They also observed a possible osseous contribution to the proximal UCL from the medial epicondyle in addition to an artery from the flexor/pronator musculature that consistently appeared to provide vascularity to the proximal UCL. The degree of vascular penetration from proximal to distal in the UCL ranged from 39% to 68% of the overall UCL length, with a 49% mean length of vascular penetration of the UCL. CONCLUSION: This study found a difference in the vascular supply of the UCL. The proximal UCL was well vascularized, while the distal UCL was hypovascular. This difference in vascular supply may be a factor in the differential healing capacities of the UCL based on the location of injury. CLINICAL RELEVANCE: An improved understanding of the macroscopic vascular supply of the UCL may aid in the clinical management of partial UCL tears and suggests an indication for these treatments with respect to location of UCL injuries.

Reverse vascularized bone graft of the lateral distal humerus for non-union of the radial neck fracture: anatomical study and case report.

A few treatment options for radial neck non-union have been reported, including radial head excision, radial head replacement, and internal fixation with a bone graft. We describe a new treatment for radial neck non-union using a reverse vascularized bone graft of the lateral distal humerus. In the anatomical study, the posterior radial collateral artery (PRCA) was dissected in eight fresh-frozen cadaver arms. The number of branches from the PRCA to the humerus was determined, and the distances from these branches to the lateral epicondyle of the humerus were measured. We then used this information to create a reverse vascularizedhumeral bone graft, which was used to treat non-union of a radial neck fracture in a 73-year-old female. There were two to four PRCA branches (mean: 3.3) entering the bone. The distance from the branches to the lateral epicondyle of the humerus ranged from 2.5 to 10.8 cm. The mean distances from the most proximal and distal PRCA branches to the lateral epicondyle of the humerus were 7.6 cm and 3.4 cm, respectively. The case of non-union of a radial neck fracture was successfully treated with a reverse vascularized humeral bone graft. There were no major complications, and radiographs showed bony union at 8 weeks postoperatively. This procedure may become a new option for the treatment of non-union of fractures of the radial head and neck, as it enables preservation of the radial head, which is an important structure in the elbow and proximal radioulnar joints.

Prevalence of Perforated Graft in Underlay and Pop-in Technique Myringoplasty.

INTRODUCTION: The radial artery is commonly originated from the brachial artery in the cubital fossa at the level of the neck of the radius. It is the artery of choice for coronary artery angiography, percutaneous coronary artery intervention, cannulation, and others. Radial artery anomalies like high origin, tortuosity, and accessory branches are associated with the failure of such procedures. The main objective of this study is to study the variation in origin and course of the radial artery in cadavers. METHODS: A descriptive cross-sectional study was conducted in 27 formalin-fixed adult human cadavers in the Department of Anatomy, KIST Medical College and Teaching Hospital, Lalitpur, Nepal, from 2075/4/2 to 2076/4/2. Ethical approval was taken on date 02/04/2075 (IRC No. 2074/75/38). Altogether, 53 specimens were enrolled in the study by convenience sampling method. Point estimate at 95% Confidence Interval was done for binary data along with frequency and proportion. The data was analyzed by and Statistical Package for the Social Sciences version 20. RESULTS: Out of of 53 upper limbs, forty-six (86.79%) specimens, the origin of the radial artery was observed to be normal in the cubital fossa, 34.5±6.31mm below the level of the intercondylar line of the humerus with the superficial course. In seven (13.21%) specimens, the radial artery showed variation in the origin. Among them, variations in origin were found to be from sites like the axilla, upper-middle, and lower part of the arm. One cadaver showed a tortuous radial artery bilaterally. CONCLUSIONS: This study concludes that most of the radial artery originates in the cubital fossa from the brachial artery with few variations.

Distally Based Pedicled Flexor Carpi Ulnaris Muscle Flap: An Anatomical Study and Clinical Application.

BACKGROUND: Proximally based, pedicled flexor carpi ulnaris (FCU) muscle flap has been described previously for soft tissue coverage of the proximal forearm and elbow. No studies have been done on the distal muscular perforators and its use as a distally based flap. METHODS: Ten fresh-frozen cadaveric dissections were done. Specimens were injected with latex to facilitate identification of the perforators. Distal muscular perforators were dissected and distances of the pedicles from the distal wrist crease and ulnar styloid were measured and recorded. A clinical case is also presented where a distally based FCU muscle flap was used for coverage in a patient with median nerve neuroma. RESULTS: A distal muscular perforator and a second more proximal perforator were identified in all specimens. The average distance from the most distal muscular perforator to the ulnar styloid was 3.0 cm. The average distance to the wrist crease was 4.6 cm. The more proximal perforators had an average distance to the ulnar styloid and wrist crease of 7.3 cm and 8.8 cm, respectively. At 7 months post-op, the patient who underwent median nerve neurolysis and coverage with pedicled FCU flap had much improved sensation, with complete resolution of pain and tingling, and without any functional deficits. CONCLUSIONS: The use of a distally based FCU muscle flap is a good option for soft tissue coverage of the distal forearm, wrist, and hand. The distal muscular perforators from the ulnar artery exhibit a relatively consistent anatomy.

Effect of pistachio on brachial artery diameter and flow-mediated dilatation: A systematic review and meta-analysis of randomized, controlled-feeding clinical studies.

BACKGROUND: Results of previous clinical trials evaluating the effect of pistachio supplementation on endothelial reactivity (ER) are controversial. AIMS: We aimed to assess the impact of pistachio on ER through systematic review of literature and meta-analysis of available randomized, controlled-feeding clinical studies (RCTs). METHODS: The literature search included SCOPUS, PubMed-Medline, ISI Web of Science and Google Scholar databases up to 1st August 2017 to identify RCTs investigating the impact of pistachio on ER. Two independent reviewers extracted data on study characteristics, methods and outcomes. Overall, the impact of pistachio on ER was reported in 4 trials. RESULTS: The meta-analysis did not suggest a significant change in brachial artery flow-mediated dilatation (FMD) (WMD: +0.28%; 95%CI: -0.58, 1.13; p = 0.525) while brachial artery diameter (BAD) improved (WMD: +0.04%; 95%CI: 0.03, 0.06; p<0.001) following pistachios consumption. CONCLUSION: The present meta-analysis suggests a significant effect of pistachios on ER, affecting BAD but not FMD.

Vascularized Distal Radius Bone Graft for Treatment of Ulnar Nonunion.

Various methods have been reported to treat forearm nonunions with good results. However, in the presence of infection, inadequate vascularity of surrounding tissues, or failed prior grafts, vascularized bone grafts are a valid alternative. We describe the surgical technique to obtain distal radius vascularized bone graft pedicled on the radial artery (RA) and its clinical application in 1 case of an ulnar nonunion. We studied the surgical technique in 12 freshly injected cadavers. In the distal forearm, the RA provides several periosteal branches to supply the distal radius metaphysis. These vessels are located between the distal insertion of the brachioradialis and the deep surface of the radial half of the pronator quadratus. A 6-cm vascularized bone graft can be harvested from the radius, and dissection of the RA enables a long pedicle with a wide arc of rotation readily able to reach the proximal part of the ulna. The present technique is a reproducible alternative that allows the treatment of bone defects up to 6 cm, without the potential technical difficulties of a free bone flap.

Bifurcation of brachial artery into a common radial-interosseous trunk and superficial ulnar artery: a rare variation.

Variations in the branching pattern of brachial artery and abnormal course of its branches are not uncommon. The present article describes a case of bifurcation of the brachial artery into a common radial-interosseous trunk and superficial ulnar artery. The embryological basis behind the present case report could be, the radial artery establishing a connection with the axis artery just below the level of origin of ulnar artery, the posterior interosseous artery arising from the axis artery distal to the origin of the radial artery. The part of axis artery between origin of ulnar and radial artery must have developed into the common radial-interosseous trunk. The part of axis artery between origin of radial and posterior interosseous arteries develops as the common interosseous artery. The superficial position of ulnar artery could enable the surgeons in raising a free ulnar forearm flap for head and neck reconstructive surgeries.