Anatomical and Clinical Perspective of Medial Arm Region Perforators-A Potential Flap for Reconstructive Surgeries

摘要

The medial arm region can be a potential donor site for the flap surgeries because of its excellent colour and ideal thickness. It is an excellent choice for coverage of elbow, axilla, distant microvascular transfer, as the free posterior brachial fascial flap or the superficial circumflex iliac artery perforator flap, to head and neck, upper and lower extremities.Aim: To locate a consistent site and dimensions of perforators in medial arm region so as to make it easier for surgeons to design medial arm perforator flaps for various surgeries.Materials and Methods: 30 upper limbs of 15 fresh adult cadavers with mean age of 79±3 years were studied. Dimensions, total number, location and source vessel of individual perforators were determined. Also, brachial artery, its branches and course along with variations, if any were studied.Results: Consistent location was found to be 9.32±0.46 cm proximal and 4.4±1.72 cm medial to the medial epicondyle. Total number of perforators was 192. Brachial artery was the main source vessel in 67% (128) of cases, followed by superior ulnar collateral artery in 28% (54) of the cases. 56% (107) of the perforators had diameter more than 0.5 mm, while 33% (64) had diameter more than 1 mm. Mean length of perforators was found to be 33.76±0.52 mm.Conclusion: Larger the diameter of the perforator lesser is the chances of necrosis of the flap due to better vascularisation. As 89% (171) of perforators in the medial arm region had diameter more than 0.5 mm, there are higher chances of successful flap surgeries. Knowledge of consistent position of perforators can help in designing of flaps accordingly.