Radial-Side First Technique: Revisiting the Radial Forearm Flap Dissection in a Cadaveric Model

This study details an anatomical dissection of the radial forearm flap, a cornerstone in reconstructive surgery. It explores an alternative approach by initiating dissection from the radial side, contrary to the traditional ulnar-side start. This method demonstrates the feasibility, safety, and efficacy of achieving early access to key structures, including the radial artery, venae comitantes, nerves, veins, and tendons. A dissection was performed on a formalin-fixed human specimen. The flap was designed around the radial artery. Radial-side dissection provided immediate access to the distal radial artery and facilitated preservation of the superficial radial nerve. Subsequent ulnar-side dissection proceeded suprafascially from proximal to distal, identifying the palmaris longus and flexor carpi radialis. Critical structures, including the lateral antebrachial cutaneous nerve, were meticulously isolated and preserved. Standard surgical instruments were used for dissection and ligation. As a cadaveric study, direct applicability to live surgery may be limited due to variances in patient anatomy, tissue viability, and intraoperative dynamics. Surgeon-specific factors such as experience and preference were not assessed. Initiating dissection from the radial side facilitates early control of critical vasculature and enables precise preservation of neural and vascular elements. This approach offers significant procedural benefits; however, further clinical studies are necessary to validate its efficacy across the variability inherent in live surgical procedures.