Median artery arising from the radial artery: its significance during harvest of a radial forearm free flap.

Variations in the radial arterial system, although rare, may still be encountered during harvest of a radial forearm flap. The reconstructive surgeon should be aware of these possible variations as some may significantly affect the harvest, jeopardising the survival of the radial forearm flap as well as causing ischaemia in the hand. We present a case with coexisting anomalies of the radial arterial system encountered during the harvest of the radial forearm flap, which has never before been described in the reconstructive surgery literature. In this patient the radial artery supplied the overlying skin with only a single small proximal perforator; a median artery existed and arose from the radial artery; the median artery supplied the forearm with unusually large perforators which passed ulnar to the flexor carpi radialis tendon; and the common interosseous artery originated from the radial artery. It is important for the reconstructive surgeon to be aware of these anomalies for the success of the operation. The embryology, incidence and significance of the median artery during radial forearm free flap harvest are also discussed.