Called Lateral Pair Of Artery Perforator Flap Of Anatomical Study And Clinical Application

Chapter I Applied Anatomic Study of Radial Collateral ArteryPerforator FlapObjective To provide applied anatomy basis for the radial collateral arteryperforator flap by observing the origin, course, branches, distribution and anastomosisof radial collateral artery perforators．Methods Choose8fresh upper limbs from Chinese adult cadavers and performmicro-anatomy injected with red latex. Take the deltoid insertion as the upper bound,the lateral epicondyle of humerus as the lower bound, the midline of the rear arm asthe lateral border, and the margo medialis of the arm foreside as the inner sphere,which anatomic range was separated into thirds equally named A、B、C from near-endto far-end. Observe the origin of radial collateral artery, the number of perforators,and the regularities of distribution of the perforators in these areas, their averageexternal diameters at the origin, an average pre-fascial length, the distances from theperforating point to lateral epicondyle of humerus. One of the specimens wassimulated the operation of the radial collateral artery perforator flap. The data wereanalyzed with SPSS11.0statistical software.Results In the8specimens, it was found that in7specimens the radialcollateral artery were derived from deep brachial artery(account for87.5%),and theother one was derived from posterior humeral circumflex artery(account for12.5%).Totally26radial collateral artery perforators were found in8upper arms (on average3.2), and among them there were13perforators (on average1.6) whose diameterswere equal or greater than0.5mm. In the areas of A、B、C, the radial collateral arteryemited respectively5perforators(account for19.2%)、14perforators (account for53.8%)、7perforators (account for26.9%). And the amounts of the perforators whosediameters were equal or greater than0.5mm were4（account for15.3％）、6（accountfor23.1％）、3（account for11.5％）, respectively. The perforators had an averagestarting diameter of (0.71±0.11)mm, an average pre-fascial length of (l.17±0.39)cm, an average length of (60.9±6.80)mm in intermuscular ligament of arm and anaverage length of (9.80±3.69)cm from the perforating point to lateral epicondyle ofhumerus. The perforators interlink with each other to form longitudinal vascularanastomosis. The dominant vascular supply to the flap is stable, reliable.Conclusion The presence of radial collateral artery perforator is consistent. Inarea B, the amount of the perforators was maximum whose diameters were larger,which was the main portion for the free flap. It can offer adequate vascular pedicleand desirable caliber of vascular anastomosis with original artery. And its anatomiccharacteristic is very suitable for free grafting. Chapter II Clinical Study of Radial Collateral Artery PerforatorFlapObjective To probe the feasibility and therapeutic effect of repairing small tomedium size soft tissue defects in the hands with the radial collateral artery perforatorflap.Methods From January2008to June2011, twenty-three patients with soft tissuedefect in the hands were treated with the radial collateral artery perforator flap by freetransfer. The center of these flaps was on9.80±3.69cm proximal of the lateralepicondyle of humerus and the flaps were in area B mainly. The size of the flapsranged from4.0cm×2.0cm to16.0cm×7.0cm. The patients were evaluated at3,6,9and12months on the postoperative follow-up parameters including flap contour,blood supply, flap stability, locomotor activity, restoration of touch sensation, as wellas the shape and motor function in donor site.Results21flaps survived smoothly in this group. Only2flaps had vein articulo.But the flaps also survived after the articulo was removed by suitable healing.Postoperative follow-up ranged from3months to12months (8months on average). The appearance and texture of the flaps were in good condition. All flaps but3werethin, and no ulceration happened. The flap sensation recovered to S3or higher. Therewere no obvious complications of the donor site and only some scars were left. Andthere was no effect on their motor function.Conclusion the radial collateral artery perforator flap has consistent anatomyand reliable blood supply, and does not sacrifice a major artery. The flap is thin,having pleasing appearance, favourable sensation, soft texture and minor surgicaltrauma. It is a good method to repair small to medium size soft tissue defect of thehands.