Anatomical analysis of antebrachial cutaneous nerve distribution pattern and its clinical implications for sensory reconstruction

Autoři: Hui Li aff001;  Weiwei Zhu aff001;  Shouwen Wu aff001;  Zairong Wei aff002;  Shengbo Yang aff001
Působiště autorů: Department of Anatomy, Zunyi Medical University, Zunyi, Guizhou, China aff001;  Department of Plastic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0222335


This study aimed to reveal the distribution pattern of antebrachial cutaneous nerves and provide a morphological basis for sensory reconstruction during flap transplantation. Forearm specimens containing skin and subcutaneous fat were obtained from 24 upper extremities of 12 adult cadavers. Cutaneous nerves were visualized using modified Sihler's staining. Then the data was used to show the distribution pattern and innervation area of the forearm cutaneous nerve. The anterior branch of lateral antebrachial cutaneous nerve innervates 26% of the medial anterior forearm; the posterior branch innervates 38.21% of the lateral anterior forearm and 24.46% of the lateral posterior forearm. The anterior branch of medial antebrachial cutaneous nerve innervates the medial aspect of the forearm covering 27.67% of the anterior region; the posterior branch the lateral part of the forearm covering 7.67% and 34.75% of the anterior and posterior regions, respectively. The posterior antebrachial cutaneous nerve covers 41.04% of the posterior forearm. Coaptations were found between the branches of these cutaneous nerves. The relatively dense secondary nerve branches were found in the middle 1/3 of the lateral anterior forearm and the middle 1/3 of the medial posterior forearm. The relatively dense tertiary nerve branches were the middle 1/3 and lower 1/3 of the medial anterior forearm. The intradermal nerve branches were the relatively dense in the middle 1/3 of the medial anterior and lateral posterior forearm. The middle 1/3 of the medial and lateral forearm had the relatively dense total nerve branches. These results can be used sensory matching while designing forearm flaps for reconstruction surgeries to obtain improved recovery of sensory.

Klíčová slova:

Biology and life sciences – Anatomy – Musculoskeletal system – Body limbs – Nervous system – Integumentary system – Skin – Neuroscience – Cellular neuroscience – Neurons – Nerve fibers – Cell biology – Cellular types – Animal cells – Biochemistry – Lipids – Fats – Medicine and health sciences – Arms – Forearms – Skeleton – Humerus – Neuroanatomy – Skin anatomy – Surgical and invasive medical procedures – Plastic surgery and reconstructive techniques – Skin grafting – Physical sciences – Mathematics – Statistics – Statistical data


1. Masear VR, Meyer RD, Pichora DR. Surgical anatomy of the medial antebrachial cutaneous nerve. J Hand Surg Am. 1989; 14: 267–271. 2703673

2. Prakash KM, Leoh TH, Dan YF, Nurjannah S, Tan YE, Xu LQ, Lo YL. Posterior antebrachial cutaneous nerve conduction studies in normal subjects. Clin Neurophysiol. 2004; 115: 752–754. 15003753.

3. Moritz T, Prosch H, Pivec CH, Sachs A, Pretterklieber ML, Kriechbaumer L, et al. High-resolution ultrasound visualization of the subcutaneous nerves of the forearm: A feasibility study in anatomic specimens. Muscle Nerve. 2014; 49: 676–679. 24038104.

4. Im HS, Im JY, Kim KH, Kim DH, Park BK. Ultrasonographic study of the anatomical relationship between the lateral antebrachial cutaneous nerve and the cephalic vein. Ann Rehabil Med. 2017; 41: 421–425. 28758079.

5. Maida E, Chiavaras MM, Jelsing EJ, O'Driscoll SW, Pawlina W, Smith J. Sonographic visualization of the posterior cutaneous nerve of the forearm: Technique and validation using perineural injectionsin a cadaveric model. J Ultrasound Med. 2017; 36: 1627–1637. 28390161.

6. Hirtler L, Huber FA, Wlodek V. Cutaneous innervation of the distal forearm and hand: Minimizing complication rate by defining danger zones for surgical approaches. Ann Anat. 2018; 220: 38–50. 30048757.

7. Kawakami T, Ishihara M, Mihara M. Distribution density of intraepidermal nerve fibers in normal human skin. J Dermatol. 2001; 28: 63–70. 11320708.

8. Chakravarthy MS, Kumar P, Dhalapathy S, Marx AC. Microanatomical and immunohistochemical study of the human anterior branch of the medial antebrachial cutaneous nerve of forearm at the antecubital fossa and its clinical implications. Rom J Morphol Embryol. 2010; 51: 337–346. 20495753.

9. Chakravarthy MS, Kumar P, Dhalapathy S, Marx AC. Distribution of sympathetic fiber areas in the sensory nerves of forearm: an immunohistochemical study in cadavers. Rom J Morphol Embryol. 2011; 52: 605–611. 21655650.

10. Tank MS, Lewis RC, Coates PW. The lateral antebrachial cutaneous nerve as a highly suitable autograft donor for the digital nerve. J Hand Surg Am. 1983; 8: 942–945. 6643977.

11. Loewen IJ, Boliek CA, Harris J, Seikaly H, Rieger JM. Oral sensation and function: A comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck. 2010; 32: 85–95. 19536773.

12. Liang J, Yu T, Wang X, Zhao Y, Fang F, Zeng W, et al. Free tissue flaps in head and neck reconstruction: Clinical application and analysis of 93 patients of a single institution. Braz J Otorhinolaryngol. 2018; 84: 416–425. 28571928.

13. Bertelli JA. Neurocutaneous axial island flaps in the forearm: anatomical, experimental and preliminary clinical results. Br J Plast Surg. 1993; 46: 489–496. 8220856.

14. Taylor GI, Gianoutsos MP, Morris SF. The neurovascular territories of the skin and muscles: Anatomic study and clinical implications. Plast Reconstr Surg. 1994; 94: 1–36. 8016221.

15. Bertelli JA, Kaleli T. Retrograde-flow neurocutaneous island flaps in the forearm: Anatomic basis and clinical results. Plast Reconstr Surg. 1995; 95: 851–859. 7708869.

16. Rhee JS, Weisz DJ, Hirigoyen MB, Sinha U, Alcaraz N, Urken ML. Intraoperative mapping of sensate flaps: Electrophysiologic techniques and neurosomal boundaries. Arch Otolaryngol Head Neck Surg. 1997; 123: 823–829. 9260547.

17. Yang S, Hu S, Li B, Li X. Localization of nerve entry point and intramuscular nerve-dense regions as targets to block brachioradialis muscle spasticity. Int J Clin Exp Med.2017; 10: 11912–11920.

18. Tang S, Zhang XM, Yang S. Localization of center of intramuscular nerve dense regions in adult anterior brachial muscles: a guide for botulinum toxin a injection to treat muscle spasticity. Am J Transl Res. 2018; 10: 1220–1228. 29736215.

19. Yang HM, Won SY, Kim HJ, Hu KS. Sihler staining study of anastomosis between the facial and trigeminal nerves in the ocular area and its clinical implications. Muscle Nerve. 2013; 48: 545–550. 23588799.

20. Kwon HJ, Kim HS, Kang HJ, Kang HJ, Won JY, Yang HM, et al. Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management. J Pain Res. 2018; 11: 2023–2031. 30310306.

21. Sinis N, Lamia A, Gudrun H, Schoeller T, Werdin F. Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities. Neural Regen Res. 2012; 7: 2279–2285.–5374.2012.29.006 25538750.

22. Zhao X, Zhang Y, Fu S, Zhang C, Li M, Wu Y. Clinical application of a pedicled forearm flap in the reconstruction after oral cancer resection. J Craniofac Surg. 2017; 28: e222–e225. 28468195.

23. Katou F, Shirai N, Kamakura S, Ohki H, Motegi K, Andoh N, et al. Intraoral reconstruction with innervated forearm flap: A comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 80: 638–644. 8680967.

24. Netscher D, Armenta AH, Meade RA, Alford EL. Sensory recovery of innervated and non-innervated radial forearm free flaps: Functional implications. J Reconstr Microsurg. 2000; 16: 179–185. 10803620.

25. Meirer R, Schrank C, Putz R. Posterior radial collateral artery as the basis of the lateral forearm flap. J Reconstr Microsurg. 2000; 16: 21–25. 10668750.

26. Zhang FH, Topp SG, Zhang WJ, Zheng HP, Zhang F. Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. Microsurgery. 2006; 26: 373–385. 16783807.

27. Race CM, Saldana MJ. Anatomic course of the medial cutaneous nerves of the arm. J Hand Surg Am. 1991; 16: 48–52. 1995693.

28. Ide C, Tohyama K, Yokota R, Nitatori T, Onodera S. Schwann cell basal lamina and nerve regeneration. Brain Res. 1983; 288: 61–75. 6661636.

29. Feng SM, Wang AG, Zhang ZY, Sun QQ, Tao YL, Zhou MM, et al. Repair and sensory reconstruction of the children's finger pulp defects with perforator pedicled propeller flap in proper digital artery. Eur Rev Med Pharmacol Sci. 2017; 21: 3533–3537. 28925493.

30. Zhu L, Zhang J, Song X, Hou W, Wu S, Chen W, et al. Sensory recovery of non-innervated free flaps and nasolabial island flaps used for tongue reconstruction of oncological defects. J Oral Rehabil. 2017; 44: 736–748. 28370156.

31. Frank H. Upper limb. In: Hansen JT, Benninger B, Brueckner-Collins J, Hoagland TM, Tubbs RS, editors. Atlas of human anatomy. Philadelphia: Saunders Elsevier; 2014. pp. 400.

Článok vyšiel v časopise


2019 Číslo 9

Najčítanejšie v tomto čísle

Tejto téme sa ďalej venujú…


Zvýšte si kvalifikáciu online z pohodlia domova

Faktory ovlivňující léčbu levotyroxinem
nový kurz

Kurz originály vs. generika

Autori: MUDr. Petr Výborný, CSc., FEBO

Autori: MUDr. Jiří Horažďovský, Ph.D

Klinická farmakokinetika betablokátorů

Všetky kurzy
Zabudnuté heslo

Nemáte účet?  Registrujte sa

Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.


Nemáte účet?  Registrujte sa