Posterior Circumflex Humeral Artery Perforator Flap: A Cadaveric Study and Case Series

Abstract

Background: Reconstruction of soft tissue defects of the acromioclavicular region represents a relatively uncommon but challenging event. Many muscular, fasciocutaneous, and perforator flaps have been described, including the posterior circumflex humeral artery perforator (PCHAP) flap based on the direct cutaneous perforator of the PCHA. This study aims to describe a variant of the PCHAP flap, based on a constant musculocutaneous perforator, by means of a cadaveric study and a case series. Methods: A cadaveric study was conducted using 11 upper limbs. The perforator vessels originating from the PCHA were dissected and the musculocutaneous ones were identified and measured in their length and distance from the deltoid tuberosity. Besides, we retrospectively analyzed the posterior shoulder reconstruction conducted among 2 plastic surgery department (San Gerardo Hospital, Monza and Hospital Papa Giovanni XXIII, Bergamo) using the musculocutaneous perforators of the PCHA. Results: The cadaver dissection showed the presence of a constant musculocutaneous perforator arising from the PCHA. The mean pedicle length is 6.10 ± 1.18 cm, and the musculocutaneous perforator pierces the fascia at a mean distance of 10.4 ± 2.06 cm from the deltoid tuberosity. In all the cadaver dissected, the perforator of interest divided into 2 terminal branches, anterior and posterior, nourishing the skin paddle.In our case series, the mean age of the patients was 66.7 years, the mean size of the defect was 46 cm 2 , the mean operating time was 79.3 minutes, the mean length of hospital stay was 2.7 days, and the complication rate was 28.6%. Conclusions: According to this preliminary data, the PCHAP flap based on the musculocutaneous perforator seems to be a reliable alternative in posterior shoulder region reconstruction.

The Arterial System of the Fasciocutaneous Deltoid Flap Pedicle on 320-Detector Row Computed Tomography and Clinical Application in the Foot and Hand

“…In our series, the cutaneous branch had a diameter of 1.49 ± 0.28 mm, which was remarkably larger than that reported in previous cadaver studies. The length of the cutaneous arterial branch was 44.57 ± 4.83 mm, which was shorter compared with those reported by Garieri et al 9 and Edizer et al 11 but longer compared with those reported by Wang et al 5…”

“…In terms of the diameter and length of the cutaneous branch, Wang et al 5 reported that the outer diameter was 0.88 ± 0.19 mm and the length of this branch was 24.64 ± 16.85 mm. In 2023, Garieri et al 9 reported that the mean diameter of the cutaneous perforator artery was 0.81 ± 0.18 mm and the mean length was approximately 61 mm. In their cadaver study, Edizer et al 11 reported that the mean diameter was 0.96 mm, ranging from 0.81 to 1.33 mm.…”

“…They also reported that the mean length of this branch was 51.10 mm after piercing the deltoid muscle, with an entire course of 75.40 mm. However, Garieri et al 9 and Edizer et al 11 did not study and evaluate data relating to the diameter and length of the PCHA. In our series, the cutaneous branch had a diameter of 1.49 AE 0.28 mm, which was remarkably larger than that reported in previous cadaver studies.…”

“…5 The deltoid flap is supplied by the perforator cutaneous branches of the posterior circumflex humeral artery (PCHA); thus, it is sometimes called "the posterior circumflex humeral artery perforator flap." 1,[5][6][7][8][9][10] The PCHA branches from the proximal third of the axillary artery. [1][2][3]5,6,10 Typically, this artery runs backward alongside the axillary nerve and passes through the quadrangular space, which is bordered by the subscapularis and teres minor superiorly, the teres major inferiorly, the long head of the triceps medially, and the humerus laterally.…”