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American Association for Hand Surgery

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Safe Dissection Parameters of the Anconeus Rotational Flap for Soft Tissue Coverage at the Elbow
Victor E. Greco, MD1, Mark C Miller, PhD2, Andrew Wroblewski, MD3, Jon Hammarstedt, MD4, Nathan Winek, MD2 and Steven Regal, MD2, (1)Allegheny Health Network, Pittsburgh, PA, (2)Allegheny General Hospital, Pittsburgh, PA, (3)Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA, (4)1307 Federal Street, Pittsburgh, PA

Background: The aim of the study was to determine safe dissection parameters of the anconeus as well as map arterial pedicles to achieve successful local harvest of the muscle without devascularization.
Methods: 8 fresh frozen cadaveric arms from scapula to fingertip were obtained. First, the radial, ulnar and axillary arteries were dissected and isolated. The radial and ulnar arteries were identified/transected. 100cc mixture of Biodür/hardener (10:1) was mixed and injected into the axillary artery. The axillary artery was clamped and epoxy hardened. Dissection was performed by making a curvilinear incision centered over the lateral epicondyle. The anconeus was identified and the interval between the anconeus and ECU was then confirmed. Measurements of the anconeus muscle were taken. The RPIA was identified and protected. We isolated the MCA by dissecting proximally. MCA ran with the nerve to the anconeus. MCA was protected and the muscle reflected from distal to proximal staying along ulnar border. Branches of RPIA were ligated and dissection was continued proximally. Measurements of RPIA, MCA distances were taken.
Results: The average distance of olecranon to muscle tip was 95.0mm. The average distance of lateral epicondyle (LE) to muscle tip was 90.8mm. The average distance of LE to olecranon was 49.8mm. The average location of the RPIA was 63mm when measuring LE to vessel, 68.3mm when measuring olecranon to vessel, 18.3mm when measuring RPIA to muscle tip. The average RPIA diameter was 1.1mm and length was 36.4mm from the initial branching of the posterior interosseous artery. The average MCA diameter was 0.7mm. The posterior branch of the radial collateral artery was only found in 3/8 specimens. The RPIA and MCA were constant in all specimens. Dissection was safely carried to the border of the LE and olecranon without disruption of the MCA.
Conclusions: Our results show the RPIA remains constant between the interval of the ECU as well as anconeus at an average distance of 18.3mm from the tip of the muscle measuring proximal; moreover, the MCA was constant in all specimens found directly between the LE and olecranon always running with the nerve to the anconeus. When dissecting and mobilizing to ensure preservation of the MCA, dissection should be taken from distal to proximal as well as dissecting along the ulnar border of the anconeus. Proximal dissection can be taken as proximal as the border of the LE and olecranon as that did not disrupt MCA blood supply.





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