Anatomy And Clinical Study Of The Medial Arm Perforators Flap

Objective:Through investigated the anatomy of cutaneous perforators of medial arm, explore a kind of simple or double leaf medial arm perforator flap,to recover the defects of body, especially for the defects caused by through and through wound in the hand and maxillofacial region,so that provide anatomical basis for design and operation of the free medial ann perforator flap.Method:1.Five fresh adult cadavers(10 sides) underwent intra-arterial injection with a lead oxide and gelatine preparation.The integument of the medial arm region was dissected. Cutaneous perforators of the brachial artery and its branches were identified.Their course, number,length,diameter,distribution,location and so on were recorded by dissection and photography.2.An imitative operation of the simple and double leaf medial arm perforator flap on 2 sides fresh adult cadaver was conducted.3.In 40 arms of 20 adult volunteers,the emerging points of perforator branches of the artery were detected by Ultrasonic Doppler Flowmeter.4.In 1 clinical case,transplantation of the medial arm perforator flap with the constant perforator branch was performed to observe the effect of the operation.Results:1.In 5 fresh adult cadaver(10sides) medial arm,we found the medial arm perforators were come from the axillary artery,brachial artery,deep brachial artery,superior ulnar collateral artery and inferior ulnar collateral artery,while the superior ulnar collateral artery is the main blood-supply artery.2.In 10 sides medial arm,47 cutaneous branches were observed and average of each medial arm was 4.7 branches,there were 13 branches that its diameter over 0.5mm;The superior ulnar collateral artery gives of 23 cutaneous perforators to supply the medial arm,among of them were 8 branches that its diameter over 0.5 mm,and these perforators were included in the region between 8.3 cm to 9.8 cm above the medial epicondyle.3. We successfully designed and dissected a simple and a double leaf medial arm perforator flap on 2 sides fresh adult cadaver respectively.4.In 40 upper arms of 20 adult volunteers were detected by Ultrasonic Doppler Flowmeter,Eighty-five percent of the upper arm had a constant perforator in the region between 8.0 cm to 10.3 cm the medial epicondyle.5.Combined the result of anatomy and the detection of Ultrasonic Doppler Flowmeter,we found that there was a constant perforator in medial arm,the constant perforators were included in a circle of 2.65 cm in diameter,the center of which was 9.17cm above and 1.03 cm medial to the medial epicondyle, the constant perforators were all come from superior ulnar collateral artery,the mean length and diameter of the constant medial arm perforator was(2.85±0.62cm) and(0.76±0.11mm) respectively.6.Clinical application has been performed in 1 case.The flap size was 6×4cm and the flap survivedConclusion:1.There is a constant perforator in the medial upper arm,which is a branch of superior ulnar collateral artery,its frequency is 84%,its diameter is relatively big and its length is relatively long,the constant perforator and the flap nourished by it can be treated as a flap unit.2 The medial arm perforator flap free transfer is based on the constant perforator,its pedicle is superior ulnar collateral artery,which bring minimal operative trauma and simplifies the operative procedure.3.It is simple and reliable to use the Ultrasonic Doppler Flowmeter detect the location of constant perforator,which is conduce to the design and dissection of the flap.4. The medial arm perforator flap can be transfer to recover the defects,especially for the defects caused by through and through wound,in maxillofacial region and hand.