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Lateral Arm Flap: A Detailed Quantitative and Qualitative Cadaveric Study of Intra-Flap Perforators
Hui Qi Crystalline Lim, BSc1; Sze Wei Justin Lee, MbChB1; Quentin A. Fogg, BSc, PhD1; Andrew M. Hart, MD, PhD, FRCS2
1School of Medicine, University of Glasgow, Glasgow, United Kingdom; 2Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom

Introduction and Aims: The lateral arm flap was first popularized by Katsaros (1984) and has been widely raised for the reconstruction of hand defects. One major drawback of this flap is the addition of excessive bulk to its recipient site, which requires a secondary defatting procedure. The aim of this study is to define the anatomical variations of intra-flap perforators and to establish the arborisation through the subcutaneous fascia within the subdermal plexus of the lateral arm flap, serving as a surgical guide for safe primary thinning.

Material and Methods: 10 embalmed cadaveric lateral arm flaps were cannulated with latex dye and dissected to show the perforating branches of the posterior radial collateral artery (PRCA). All flaps underwent tissue clearing using Spalteholz technique. Pictures were taken for each specimen and analysed using Image J 1.46r. Several measurements of the flap and its respective perforators were noted.

Results: The value of the means were as follows: Flap length = 9.8 1.8 cm, Width = 4.3 0.5 cm, number of PRCA perforators = 3 1, PRCA perforator diameter = 0.90 0.19 cm, PRCA perforator length = 3.71 1.55 cm. There are three different major-branch distributions of the perforators and the perforator locations were variable. Using the vertical axis (deltoid tuberosity towards lateral epicondyle), all perforators were distributed within 30 70% of the flap. The perforators ascend distally towards the lateral epicondyle, entering the subdermal plexus mainly in the lower 30% region.

Conclusion(s): These results show that it is crucial to use the vertical axis because it serves a good surgical guide as to where is the danger zone (30 70% in this study). Knowledge on intra-flap perforator anatomy allows the lateral arm flap to be raised and thin to the sub-dermal fascial plane.


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