Summary
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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Italian contribution to plastic surgery.Ann Plast Surg. 1993; 31: 566-571
- Neurovascular free flaps. A preliminary report.Plast Reconstr Surg. 1975; 56: 13-20
- An arterial medial arm flap–vascular anatomy and clinical applications.Ann Plast Surg. 1980; 4: 205-215
- Medial upper arm skin flap: vascular anatomy and clinical applications.Ann Plast Surg. 1985; 15: 348-351
- Medial arm flap revisited.Ann Plast Surg. 1987; 18: 156-163
- The medial arm flap.Ann Plast Surg. 1992; 29: 517-522
- The cutaneous arteries of the human body.Springer-Verlag, New York1983
- The upper arm free flap.Clin Plast Surg. 1982; 9: 27-35
- Fasciocutaneous vessels in the upper arm: application to the design of new fasciocutaneous flaps.Plast Reconstr Surg. 1984; 74: 244-250
- Versatile fasciocutaneous flaps based on the medial septocutaneous vessels of the arm.Plast Reconstr Surg. 1990; 86: 103-109
- Cutaneous perforators of the upper arm and clinical applications.J Reconstr Microsurg. 2005; 21: 463-469
- Perforator arteries of the medial upper arm: anatomical basis of a new flap donor site.Surg Radiol Anat. 2013; 35: 39-48
- Vascular territories of the medial upper arm-an anatomic study of the vascular basis for individualized flap design.Microsurgery. 2017; 37: 618-623
- Perforator patterns of the ulnar artery perforator flap.Plast Reconstr Surg. 2012; 129: 213-220
- The perforasome theory: vascular anatomy and clinical implications.Plast Reconstr Surg. 2009; 124: 1529-1544
- Perforator mapping and optimizing design of the lateral arm flap: anatomy revisited and clinical experience.Plast Reconstr Surg. 2016; 138: 300e-306e
- Use of medial arm skin as a free flap.Plast Reconstr Surg. 2005; 115: 2025-2031
- Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap.J Hand Surg Am. 2012; 37: 1042-1050
- Clinical applications of perforator-based propeller flaps in upper limb soft tissue reconstruction.J Hand Surg Am. 2011; 36: 853-863
- Measurement and analysis of the perforator arteries in upper extremity for the flap design.Surg Radiol Anat. 2009; 31: 687-693
- The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps.Plast Reconstr Surg. 2011; 127: 1447-1459
- The medial arm pedicled perforator flap: application of phenomenon of one perforator perfusing multiple perforator angiosomes.Injury. 2014; 45: 2025-2028
- Propeller medial arm flap: a plan "B" for reconstruction of radiation ulcer of the chest wall.J Plast Reconstr Aesthet Surg. 2014; 67: 1769-1770
- Freestyle perforator-based propeller flap of medial arm for medial elbow reconstruction.Microsurgery. 2015; 35: 411-414
- Pre-expanded brachial artery perforator flap.Clin Plast Surg. 2017; 44: 117-128
- SPY imaging use in postmastectomy breast reconstruction patients: preventative or overly conservative?.Plast Reconstr Surg. 2016; 138: 15e-21e
- The inner arm fasciocutaneous flap.Plast Reconstr Surg. 1984; 73: 629-632
- The ulnar recurrent fasciocutaneous island flap: reverse medial arm flap.Plast Reconstr Surg. 1987; 79: 381-388
- Preexpanded pedicle medial arm flap: an alternative method of massive facial defect reconstruction.Aesthet Plast Surg. 2011; 35: 946-952
- An overview of pre-expanded perforator flaps: part 1, current concepts.Clin Plast Surg. 2017; 44: 1-11
- Perforator-plus concept: adding versatility to traditional flaps.Plast Reconstr Surg. 2009; 123: 219e-220e
- Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps.Ann Plast Surg. 2007; 59: 672-678
Article info
Publication history
Published online: February 09, 2019
Accepted:
January 18,
2019
Received:
July 9,
2018
Footnotes
Identification
Copyright
© 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
