Anterior Approach to the Forearm (Henry’s)

Indication

Safe anterior access to radius
 

Anatomy

Internervous plane:

Radial N’ supplies Lateral structures

Median N’ supplies Medial structures

Considerations

Positioning

Supine
Arm Board
Tourniquet on upper arm (Elevate, Don’t exsanguinate to keep V's engorged).
Forearm in Supination to start.

Skin Incision

Lateral to Biceps tendon (avoids radial artery running medially) to Radial Styloid.
Start and end along this line as appropriate to procedure.

Superficial dissection

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.

Deep dissection

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.

Exposure extension

Closure

Post operatively

FCR – Flexor Carpi Radialis
BR – Brachioradialis
PT – Pronator Teres
FPL - Flexor Pollicis Longus
Med. – Medial (ulnar)
Lat. – Lateral (radial)
Post. - Posterior

Mid. - Middle

References

(1) HENRY AK: Extensile exposure, 2nd ed. Baltimore, Williams & Wilkins, 1970:100

Page created by: Tim Williams

Last updated 11/09/2015