Anterior Approach to the Forearm (Henry’s)

  • Indication

  • Anatomy

  • Considerations

  • Positioning

  • Skin incision

  • Superficial dissection

  • Deep dissection

  • Exposure extension

  • Closure

  • Post operatively

  • References

  • 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