A study of the fasciocutaneous vascularisation of the arm surgical applications

Abstract

The data on the fasciocutaneous vascularisation of the medial aspect of the arm are incomplete in the literature. This study presents the methodology and results of an anatomic study on 19 upper limbs with arterial injection. The vascularisation of the upper part of this region is provided in 68% of cases by the superficial fasciocutaneous branch (SFCB) of the superior ulnar collateral artery (SUC), that of the middle and lower part by 3-4 fasciocutaneous pedicles originating from the SUC which are prolonged distally by the recurrent posterior ulnar artery. The SFCB has important relations with the ulnar nerve; it travels dorsal to the nerve in 64% of cases and then allows the raising of a distally-pedicled ulnar flap with a 3:1 ratio. In other anatomic configurations, a flap with retrograde flow supplied by the inferior pedicles of the SUC can always be raised. Its ratio is then 2:1. this flap allows coverage of all cases of posterior or anterior losses of substance at the elbow. These results supplement the data required for the raising of a distally-pedicled medial brachial flap, but also of a proximally-pedicled superior medial brachial flap and of a free superior medial brachial flap transposed by microsurgical means.

True and 'Choke' Anastomoses between Perforator Angiosomes

“…4 This being said, there are case reports where a third or even fourth angiosome has been included in a flap, with survival of the flap in its entirety. [5][6][7][8][9][10][11][12][13] The underlying cause of this inconsistency in flap survival is indisputably related to the variation in the vascular connections between angiosomes. 4 These connections between angiosomes have been well described previously with cadaveric injection studies.…”

Vascular territories of the medial upper arm—an anatomic study of the vascular basis for individualized flap design

“…Kaplan et al mentioned that the SUCA supplied three‐fourths the length of the medial arm (Kaplan & Pearl, ). Breidenbach et al and Le Huec et al reported only maximum angiosome dimensions of 6–8 × 10 cm at the medial aspect of the arm without any further information regarding shape or exact location (Breidenbach et al, ; Le Huec, Liquois, Leger et al, ). Our series of dissection included 20 arms and evaluated perforators and their corresponding angiosomes.…”