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J Plast Reconstr Aesthet Surg. 2019 Apr;72(4):600-608. doi: 10.1016/j.bjps.2019.01.025. Epub 2019 Feb 10.

Septocutaneous perforator mapping and clinical applications of the medial arm flap.

Author information

1
Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, PR China.
2
Department of Anatomy, Wenzhou Medical University, Wenzhou University Town, Wenzhou 325035, PR China.
3
Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, PR China. Electronic address: ybpumc@sina.com.

Abstract

BACKGROUND:

The medial arm flap has a long history but remains underused despite providing multiple advantages. We reviewed our experience with using the medial arm flap to clarify the distribution of septocutaneous perforators and its relationship with pedicled flap design.

PATIENTS AND METHODS:

This retrospective study included 36 consecutive patients who underwent reconstructive surgery with a medial arm flap (42 arms). Septocutaneous perforator mapping was conducted using a refined coordinate system originating at the medial epicondyle, with the y-axis running to the axillary apex.

RESULTS:

At least three perforators were identified along the medial intermuscular septum of the arm, located densely at 88 ± 8%, 49 ± 9%, and 20 ± 6% of the distance between the medial epicondyle and axillary apex (i.e., arm length), with a prevalence of 95.2%, 100%, and 85.7%, respectively. All arms had at least one medium- or large-sized perforator, and 90.5% of arms had at least two such perforators. Twenty-nine flaps were transferred as pedicled distant flaps for head and neck reconstruction or hand reconstruction, while the remaining 13 were transferred as perforator-based propeller flaps for axillary, elbow, or chest wall reconstruction. Thirty-six flaps underwent pre-transfer expansion. The average flap size was 157.9 ± 64.5 cm2 (range: 40-330 cm2). All flaps were successful, except for one perforator-based flap, which was replaced due to partial loss. Donor site morbidity was minimal.

CONCLUSIONS:

Given its rich septocutaneous perforator distribution, the medial arm flap can be harvested reliably with versatile design and minimal donor site morbidity, thus deserving more attention in reconstructive surgery.

KEYWORDS:

Clinical application; Medial arm flap; Propeller flap; Septocutaneous perforator

PMID:
30808600
DOI:
10.1016/j.bjps.2019.01.025

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