| Objective:To study the anatomical characteristic of perforators located at the lateral upper arm and to investigate the feasibility of employing the lateral upper arm perforator flap in clinical reconstruction,especially for recovering the defect of elbow.Through this study, we expect to provide anatomical basis for design and operation of the lateral upper arm perforator flap.Methods:14 sides of fresh adult upper extremity cadavers,all cadavers were injected with red latex. Microsurgical observation was conducted regarding the distribution of arterial perforators including the source artery,perforator artery (calibra≥0.5mm), length,diameter, perforation site and its anastomosis with each other on the surface of deep fascia.According to the site of the perforator,upper arm flaps based on the distal perforator or the proximal perforator were designed,whose pivot point,axis,dissection layer as well as the vascular boundary were defined. In the body after a successful operation on the specimen simulation, clinical applications and observe operation effect.Results:1. The origin of lateral upper arm perforators in the 14 side upper extremity cadavers are variable,it mainly are given off from axillary artery,posterior humeral circumflex artery,humeral artery and radial collateral artery.2.63 perforators were found in 14 cadavers,with an average of 4.5 perforators at each side perforators with a diameter greater than 0.5mm were 31.Among them,20 perforators with an average starting diameter of (0.73±0.17)mm and an average pre-fascial length of (1.1±0.5)cm.were from the radial collateral artery,which accounts for a proportion of 64.52%.11 perforators with an average starting diameter of (0.71±0.24)mm and pre-fascial length of (1.9±0.8)cm were given off from humeral artery, which accounts for a proportion of 35.48%.3. The perforators fan out at the surface of deep fascia,and the adjacent perforators interlink with each other to form longitudinal vascular anastomosis whose dominant vascular supply to the flap is stable, reliable.4. According the anatomical observation result, a distally based and proximally based upper arm perforator flap were designed:pivot point:the pivot point of proximally based upper arm perforator flap was located 14cm proximal to the lateral epicondyle of humerus, where perforator from radial collateral artery penetrate the deep fascia;the pivot point of distally based upper arm perforator flap was located 3cm proximal to the lateral epicondyle of humerus,where perforator from the end of humerus artery.Axis:the between insertion of the deltoid and lateral epicondyle of humerus.Plane:harvest the flap at the subfascial level,the proximal end can reach 5cm distal to insertion of deltoid,the distal end can reach the elbow crease,the anterior and posterior boundary can be close to the anterior and posterior line of upper arm.5.1 case of clinical application,whose size is about 8 cm X 6 cm.The flap survive uneventfully and the outcome was satisfactory.'Conclusion:1.This research enables us to have a clear idea of the origin, number, diameter, location and their anastomosis on the surface of deep fascia,which could provide a definite anatomical support to the vascular structure of the middle-proximal part of upper arm. 2.according to the characteristic of the lateral upper arm perforators,we could design a proximally based perforator flap to repair the soft tissue defect of the axillary and proximal part of upper arm, while the distally based perforator flap could be used to repair the soft tissue defect of the elbow and proximal part of forearm.The lateral upper arm perforator flap with a vascular pedicle based on radial collateral artery can be freed to repair the defect of the hand and maxillofacial region.3. The blood supply to the lateral upper arm flap is reliable.it has the advantage of minimal trauma,easy dissection and flexible design,and has been proven applicable in clinic. we had 1 case of clinical application,whose outcome is quite satisfactory. |
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