A Forearm Free Flap Based on a Persistent Median Artery.

[BACKGROUND] The median artery is an embryonic structure that usually regresses during embryonic development as the ulnar and radial arteries form but may persist into one's lifetime. Its discovery during the raising of radial forearm free flaps (RFFF) has been reported; however, there is little describing its utilization as a forearm flap pedicle.

[METHODS] A 69-year-old woman with a history of oral cavity cancer resection and osteocutaneous fibula free flap reconstruction presented with complaints of drooling. An RFFF was planned to provide soft tissue bulk and restore oral competence.

[RESULTS] We present a novel case of an RFFF harvested with a pedicle based on a persistent median artery (PMA) that pierced a bifid median nerve. The flap remained viable with no deficits in upper extremity sensation or motor function.

[CONCLUSIONS] Given the potentially rising prevalence of PMAs in the past century, surgeons must be able to identify this anatomic variant.