Anterior Approach to the Forearm (Henry’s)
Indication
Anatomy
Considerations
Positioning
Skin
incision
Superficial dissection
Deep
dissection
Exposure extension
Closure
Post
operatively
References
Safe anterior access to radius
Internervous plane:
Radial N’ supplies Lateral structures
Median N’ supplies Medial structures
Supine
Arm Board
Tourniquet on upper arm (Elevate, Don’t
exsanguinate to keep V's engorged).
Forearm in Supination to start.
Lateral to Biceps tendon
(avoids radial artery running medially) to
Radial Styloid.
Start and end along this line as appropriate to procedure.
Deep fascia cut in line with skin
incision.
Work in plane between FCR (medially) & BR (laterally.)
Start distal & work proximally.
Superficial Radial N’ (under BR) to be kept laterally.
Radial A’ (under BR in mid. section) taken medially
Ligate any small vessels tethering BR.
Proximal 1/3rd:
Ensure full supination
Stay lateral to biceps tendon to avoid radial A’
Peel off supinator insertion subperiosteally from radius
Warning Watch for post. interosseus N’ in
supinator belly. Avoid excessive traction.
Don’t use retractor on posterior radial neck to avoid post. interosseus N’
Middle 1/3rd:
Semi pronate forearm to expose
pronater teres insertion
Subperiosteally dissect off PT with FDS origin attached as required
Distal 1/3rd:
Semi supinate forearm to expose PQ
insertion.
Subperiosteally dissect off PQ with FPL from lat. – med.
Retract PQ & FPL medially.
FCR – Flexor Carpi Radialis
BR – Brachioradialis
PT – Pronator Teres
FPL - Flexor Pollicis Longus
Med. – Medial (ulnar)
Lat. – Lateral (radial)
Post. - Posterior
Mid. - Middle
(1) HENRY AK: Extensile exposure, 2nd
ed. Baltimore, Williams & Wilkins, 1970:100
Page created by: Tim Williams
Last updated
11/09/2015
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