The dorsal carpal arch is an anastomotic arcade across the dorsal wrist formed by the dorsal carpal branch of the radial artery (radial side) uniting with the dorsal carpal branch of the ulnar artery (ulnar side), running transversely across the dorsal carpal row. The second, third, and fourth dorsal metacarpal arteries arise from the arch to supply the dorsal hand and the dorsal digital arteries. The first dorsal metacarpal artery arises from the radial artery before it dips through the first interosseous space.
| Origin | Dorsal carpal branches of the radial and ulnar arteries, joined by the anterior and posterior interosseous arteries |
|---|---|
| Course | Runs transversely across the dorsal surface of the carpus deep to the extensor tendons |
| Branches |
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The dorsal carpal arch is the vascular basis for dorsal hand flaps and pedicled metacarpal artery flaps used in hand reconstruction. Distal-based metacarpal artery flaps (reverse dorsal metacarpal flaps) can reconstruct finger dorsal skin defects. The dorsal carpal arch patency is important before harvesting the radial forearm flap or performing radical wrist resection for tumours. In scaphoid vascularised bone grafting using the dorsal radius periosteal flap (Zaidemberg technique), the dorsal carpal arch provides retrograde flow.
The dorsal metacarpal arteries arising from the dorsal carpal arch provide axial-pattern pedicles for dorsal metacarpal artery flaps used to resurface finger dorsal skin defects; the first dorsal metacarpal artery flap is the workhorse for thumb dorsal reconstruction, pivoting on its radial artery origin proximal to the arch.
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