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The Flexor Carpi Radialis Muscle Turnover Pedicle Flap for Elbow Soft Tissue Reconstruction: A Cadaveric Study of Regional Coverage Based on Distal Flap Perfusion
Yash J Avashia, MD; Luke P Poveromo, BS; Travis J Dekker, MD; Jacob W Brubacher, MD; David S Ruch, MD; Suhail K Mithani, MD
Duke University, Durham, NC
Background: Elbow wounds present a unique challenge for the reconstructive surgeon. The brachioradialis (BR) and flexor carpi ulnar (FCU) muscles are two described options for rotational elbow coverage. The Flexor Carpi Radialis (FCR) is a commonly used muscle for tendon transfers; its vascular anatomy has not been well described for its potential application as a rotational muscle flap. The purpose of this study is to analyze the vascular perfusion, arc of rotation, and coverage potential of the FCR based on perfusion from its most proximal vascular pedicle, a branch of the radial artery.
Methods: In 5 fresh-frozen, proximal humeral human amputation specimens, the FCR muscle was elevated from distal to proximal, preserving the most proximal primary vascular pedicle to the muscle belly from the radial artery The axillary artery was injected with India ink after ligation of the radial and ulnar arteries at the wrist. After injection, each specimen was sectioned transversely at 0.5 cm increments to assess vascular perfusion of the muscle using loupe magnification. Regional coverage and arc of rotation was then assessed based on muscle belly perfusion data.
Results: The average distance from the olecranon tip to the distal FCR musculotendinous junction was 16 cm. The primary vascular pedicle that would allow a proximal turnover flap was, on average 4.8 cm distal to the muscle origin. Perfusion of the FCR muscle was measured distal to this primary pedicle. Ink staining was present in 50 to 100% of the surface area of the muscle belly at an average of 10.4 cm from origin. Perfusion of 25% to 50% of the FCR muscle belly was present at an average of 13.6 cm from the origin. Perfusion became less consistent (<25%) within the muscle belly at an average distance of 16 cm. With preservation of the origin and most proximal vascular pedicle, the FCR muscle belly had sufficient perfusion to provide rotational coverage of the lateral epicondyle, antecubital fossa, and olecranon tip in all cadavers.
Conclusion: Use of a proximally based, pedicled FCR muscle rotational flap provides an option for soft tissue reconstruction at the lateral epicondyle, antecubital fossa, and olecranon tip. Due to diminished distal flap perfusion based on the primary vascular pedicle, contralateral condyle coverage was not consistently demonstrated.
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