Anatomical Study Of The Medial Upper Arm Flap And Clinical Applications

Objective To investigate the blood supply of the expanded skin flap from medial upper arm and its application on the reparation of facial and cervical defect due to scar resection.Methods Microsurgical anatomical study was carried out on 10 fresh upper limbs of human cadavers, which had been injected with red and blue latex. The study was focused on the origin, numbers, position and vascular anastomosis of perforator artery (diameter≥0.30mm)origiated from brachial artery. The flaps were used on 24 cases to repair the facial ang cervical defect.Results1. 8～9cutaneous arteries are given off from brachial artery at the layer of the deep fascia ,these branches which give off the ramus anastomoticus also tend to anastomose in the deep fascial, superficial fascia and subdermal level respectively,they shape the vascular network on the deep fascia ,in the superficial fascia and subdermal level and are the main supplying vessels. More ramus anastomoticus are observed on the medial intermuscular septum ,and then posterior part of the arm. There are total 84 cutaneous artery perforators in 10 upper limbs,most of them locate at the medial intermuscular septum.2.The expanded skin flaps from medial upper arm were used on 24 cases to repair the facial and cervical defect. The maximum area of the flap was 20cm×15cm and the minimum was 4cm×5.5cm. The flap was separated on the deep fascia,in 12 cases the pedicle located at the proximal upper arm and 15 cases at the distal upper arm. Only two flaps necrosed partially, all the others survived .The donor sites were sutured directly except two cases in which the donor site were covered with free graft. The results were satisfying. Conclusions1. The blood supply of the medial upper arm flap is sufficient,branches of the cutaneus artery anastomose along the longitude direct of the intermusular septum,so the flap which is separated on the deep fascia along intermusular septum is safe,if larger flap is needed the flap can be extended to the posterior. Intermusular septum is the better position of the pedicle.2. Reparation of facial and cervical defects with medial upper arm skin flap after expanding could be recommended because of its nearly normal skin color,texture and contour. Larger flap can be obtain after expanding.