The medial arm fasciocutaneous flap: a wasted alternative?

Abstract

The medial side of the upper arm is supplied by perforator arteries arising from the brachial artery, the superior ulnar collateral artery and the artery to the biceps muscle. Fasciocutaneous flaps from the medial arm region could be designed based on these perforating arteries, but the anatomical variability of this region has led to a loss of interest in it as a donor area for fasciocutaneous flaps. The aim of this study is to identify, through cadaveric dissection, whether there are constant perforator arteries from the brachial artery that could be used to raise fasciocutaneous flaps from the inner side of the arm. For this purpose, 15 upper extremities belonging to body-donors have been dissected. Six extremities were right-side arms and six belonged to female donors. 7 parameters and the differences between gender and side of the upper extremity were studied (distances from the acromion and the coracoid to the beginning and to the end of each perforating artery, distance from the insertion of the distal tendon of the biceps muscle to the origin of each perforator artery, length and diameter of the perforators arteries). Perforator arteries arising from the brachial artery to the inner face of the arm were found in all the upper limbs dissected. The median number of these perforator arteries found by the upper limb was 5±1.9 (range 3-9). Anatomical variations consisted of the number of perforator arteries that were found in each limb. Only in 2 arms (13.3%), the perforator arteries arose from a superficial brachial artery or from the distal part of the brachial artery. The mean diameter of the perforating artery was 1.80±0.58 mm, and the mean length resulted in 4.67±2.07 cm. The consistent vascular anatomy found for these perforator arteries, arising from the brachial artery, and the easy landmarks described justify the use of fasciocutaneous flaps of the medial side of the arm for reconstructive surgery.