Reexploring the Anatomy of the Distal Humerus for its Role in Providing Vascularized Bone

Abstract

Background:The lateral arm flap is used for composite defects in need of vascularized soft tissue, skin, and bone. From its original description, the distal humeral metaphysis can be included with the flap, supplied by the periosteal extensions of the posterior branch of the radial collateral artery. We sought to reexplore the anatomy of the lateral arm to determine its utility as a donor site for vascularized bone.Methods:Twelve fresh, silicone-injected cadaver dissections were performed. Arteriovenous anatomy, pedicle length and diameter, and anatomic variability as well as photo documentation was recorded.Results:The distal extent of the deltoid, lateral intermuscular septum and lateral humeral epicondyle were identified before the dissection. A septocutaneous perforator was consistently located 10 cm proximal to the lateral humeral epicondyle, which could be used for a skin paddle to monitor. Harvest of a 1.5 cm × 2 cm corticocancellous bone graft was performed. Average pedicle length was 9.1 ± 1.1 cm, and average pedicle diameter was 1.74 ± 0.52 mm. The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm were consistently identified and preserved.Conclusion:The predictable anatomy of the lateral distal humerus make it an ideal donor site for small segments of vascularized bone.

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

“…In our study, the periosteal branch of the PBRCA was found in the lateral humeral epicondylar region in all patients. This result is similar to previous anatomical research findings (Carr et al, 2018;Casoli et al, 2004;Cormack & Lamberty, 1984;Sun et al, 2016).…”

“…Compared to other FVBG techniques, the most significant advantage of this procedure is minimal damage to the donor site, as it does not affect the articular surface or ligaments of the elbow (Carr et al, 2018). This ensures that the patient's elbow function and stability are not compromised.…”

“…The anterior branch of radial collateral artery is followed by the radial nerve, passing through the lateral intermuscular septum between the brachial muscle and the brachioradialis muscle to the anterolateral aspect of elbow joint and anastomoses with the radial recurrent artery. The posterior branch of radial collateral artery (PBRCA) descends between the triceps brachii muscle and the brachioradialis muscle to the lateral epicondyle of the humerus anastomoses with the recurrent interosseous artery at the level of the olecranon (Carr et al, 2018; Casoli et al, 2004; Sun et al, 2016). The PBRCA sends out 2–5 periosteal branches, which subsequently spread throughout the periosteum on the lateral surface of the lower one‐third segment of the humerus (Figure 1).…”