The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications

Abstract

Background The neurocutaneous flap is an axial pattern flap that receives a vascular supply from a vessel along its cutaneous nerve and has favorable outcomes when used for soft tissue reconstruction in the upper extremities. The neurocutaneous flap depends on the lateral antebrachial cutaneous nerve (LACN) and its retrograde-flow has been studied via cadaveric dissection. The aim of this study is to prove the vascularity of the lateral antebrachial neurocutaneous (LABN) flap. Methods The distally based LABN flap was created in 18 upper limbs (12 cadavers). The skin flap was dissected at the proximal half of the forearm and then diluted methylene blue was injected through the brachial artery. The pedicle of the flap on the distal half of the forearm was dissected along the LACN for the anatomical study of the perforating branches, paraneural vessels, and flap territory. Results The mean age of cadavers was 74.1 years (nine males). The mean distance of most distal and proximal perforating branches from the radial styloid process were 2.32 ± 0.59 and 11.17 ± 1.72 cm, respectively. The mean total number of perforating branches was 7.4, which abundantly appeared approximately 4 to 5 cm from the radial styloid process. The mean flap territory was 8.64 ± 0.82 cm in width and 10.50 ± 1.90 cm in length. The mean forearm circumference was 24.84 ± 1.52 cm, and mean forearm length was 24.74 ± 1.8 cm. Conclusion This study ensured that retrograde-flow via the neurocutaneous artery could be provided through the vascularity of the LABN flap, which suggests that the pivot point of the flap should not extend beyond 5 cm proximal to the radial styloid process. The LABN flap is a useful alternative method for performing soft tissue reconstruction in hand and wrist defects without sacrificing the major vessels.

Clinical significance of the secondary pedicle amputation of the repair of distal defects with pedicled axial flap

“…In this study, we did not strip the subcutaneous tissue between the donor site and primary wound, which would bring the following benefits: the destruction of normal tissue was reduced, the formation of the local scar was reduced, the congestion of the vascular pedicle between the donor site and the primary wound was reduced, and the morphological damage was avoided, so the long‐term benefits were clear. Previous studies have found that 20 the volume of the subcutaneous tunnel was 3 to 5 times that of the nutrient pedicle, and the stripping range was large, and the cost of injury was high. In this study, the ilioinguinal flap was used to repair the skin defect after excision of extensive Paget's disease of penis and scrotum.…”

Hand Surgery in Thailand

“…28 • For free-flap coverage, Kanit Sananpanich and Jirachart Kraisarin from Chiang Mai Hospital reported the descending geniculate artery-free flap 29 Thepparat Kanchanathepsak from Ramatibodi Hospital reported the lateral antebrachial neurocutaneous flap. 30 The resurfacing of thumb with neurovascular island flap from Pravit Kitidumrongsook 31 from Chulalongkorn hospital. Surasak Jitprapaikulsarn from buddhachinaraj hospital also reported the use of combined medial gastrocnemius and hemisoleous flap for tibial coverage.…”