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

Tinhofer, Ines; Tzou, Chieh‐Han John; Duscher, Dominik; Pollhammer, Michael S.; Weninger, Wolfgang J.; Huemer, Georg M.; Schmidt, Manfred

doi:10.1002/micr.30103

Cited by 20 publications

(12 citation statements)

References 30 publications

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“…In addition, the superficial brachial artery, the branches of the biceps artery, the direct cutaneous branches of the brachial artery were also reported as the pedicle artery. 3,8,14 Tinhofer 12 provided clinically data concerning the variable vascular anatomy and demonstrated how to safely design its individual anatomy, matching the varying shapes and sizes of angiosomes.…”

Section: Discussionmentioning

confidence: 99%

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience

Chen

et al. 2022

Journal of Craniofacial Surgery

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Purpose: To present our experience with pre-expanded medial upper arm flap in facial and neck reconstruction. Patients and Methods: This was a retrospective study operated between January 1st, 2001 and January 1st, 2021, at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Staged face and/or neck reconstruction was performed. Results: Forty-one patients were treated in our institution and thirty-eight patients (forty-three flaps) were included in this cohort as. They ranged from 6 to 44 years old. There was no total flap loss in the cohort. Partial flap necrosis was observed in the earlier patients (4 cases). Conclusion: Pre-expanded medial upper arm flap is well matched to the facial and neck skin in color, texture, and thickness. Considering the excellent aesthetic outcomes, this flap is a good alternative for selected patients with soft tissue defects of the head and neck.

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Section: Discussionmentioning

confidence: 99%

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience

Chen

et al. 2022

Journal of Craniofacial Surgery

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“…Previous anatomical studies have demonstrated that the septocutaneous perforators provide the major blood supply of the medial arm flap, 5,6 further studies have clarified the distribution characteristics of these perforators. 6,[17][18][19] The perforator distribution characteristics show that when the medial arm is trisected, constant perforators can be found in each third of the medial arm. 6 Based on these perforators, both proximally and distally based pedicled flap can be designed and elevated for cervicofacial reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Cervicofacial Defect Reconstruction Using the Pre-Expanded Medial Arm Flap Without Immobilization of the Upper Extremity

Yue

Liu²,

Zhu³

et al. 2021

Journal of Craniofacial Surgery

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The medial arm flap has multiple advantages when used for cervicofacial defect reconstruction but remains underused. The main drawback of the medial arm flap is that the patient must maintain the passive immobilized posture before the pedicle division. This clinical study aims to introduce a reconstructive method for cervicofacial defects using the medial arm flap without the immobilization of the upper extremity. This retrospective study was performed with data from 14 patients requiring pre-expanded medial arm flaps to reconstruct cervicofacial defects. Indocyanine green (ICG) angiography was used to detect perforators and evaluate the flap perfusion; all the flaps underwent pre-transfer tissue expansion. A total of 15 full-length medial arm flaps were used. All the perforators identified by ICG angiography were directly visualized during flap elevation. In four cases, poor perfusion areas in the flaps were noted by intraoperative ICG angiography. Combined with the clinical observation, parts with poor perfusion were resected. The average flap size was 203.9 AE 75.2 cm 2 and ranged 20 to 28 cm in length after tissue expansion. The medial arm donor sites were closed directly or using another flap. All flaps survived completely. The patients were followed-up for 1 to 22 months. All patients and their family members were satisfied with the outcomes. Cervicofacial defect reconstruction using a medial arm flap with the aid of tissue expansion and ICG angiography can provide sufficient tissue for defect resurfacing and also eliminate the necessity of the immobilization of the upper extremity during surgery.

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“…With the development of the perforator flap concept over the past several decades, 18,19 we have come to understand that the perfusion of the medial arm tissues is through septocutaneous BAPs; subsequently, the use of the BAP flap in clinical practice has been refined considerably. 7,12,13 A full-length BAP flap could be safely harvested with a single, pulsatile perforator from the brachial artery and robust venae comitantes. 3,7 When combined with tissue expansion, both flap vascularity and size can be greatly augmented, allowing for the reliable transfer of a large area of skin with primary closure of the donor site in a majority of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Several cadaveric and clinical studies have attempted to characterize the perforators of the medial arm using various methodologies. 7,[11][12][13]20,21 Despite their efforts, we have yet to reach a consensus on the anatomical details. As such, we prefer mapping the perforators within the region of the pedicle for each patient, as it can aid in flap design, expedite flap dissection, and avoid unintended injuries to the vascular pedicle.…”

Section: Discussionmentioning

confidence: 99%

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Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

et al. 2020

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The tissues of the medial arm as a donor site for perforator flap design have several advantages. However, they are relatively underused with limited reports, partly due to unreliable perforator anatomy. Therefore, we aimed to review our preliminary experience using indocyanine green (ICG) angiography to design and elevate preexpanded pedicled brachial artery perforator (BAP) flaps for regional reconstruction. All patients underwent soft tissue reconstructions using a preexpanded BAP flap in two or three stages. ICG angiography was used to localize perforators during both expander insertion and flap elevation. The pedicle was divided at the third stage 3 weeks following flap elevation for head and neck cases. Sixteen patients underwent reconstructions of the head and neck (n = 13) or shoulder/trunk (n = 3) using 14 perforator-plus and 2 propeller BAP flaps. In total, 50 perforators were identified using ICG imaging, all of which were appreciable during both expander placement and flap elevation. Thirty-five perforators were directly visualized during flap elevation, and an additional 15 perforators were not explored but incorporated into the flap. All flaps survived without necrosis, and the donor sites healed uneventfully without complications. The medial arm provides thin and pliable skin for the resurfacing of regional defects with relatively minimal donor-site morbidity. With the assistance of ICG angiography, perforators of the brachial artery can be reliably identified, facilitating the preexpansion and elevation of pedicled BAP flaps for use in head–neck and trunk reconstruction.

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

Abstract: This anatomical study provides valuable data of the medial arm flap in order to be applied clinically. © 2016 Wiley Periodicals, Inc.

Cited by 20 publications

References 30 publications

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience

Cervicofacial Defect Reconstruction Using the Pre-Expanded Medial Arm Flap Without Immobilization of the Upper Extremity

Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

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