Distribution of the septocutaneous perforators in the medial arm and its clinical applications / 中华整形外科杂志

ABSTRACT

Objective@#To investigate the distribution of the septocutaneous perforators in the medial arm and its clinical applications.@*Methods@#Between March 2014 and August 2018, 39 patients (45 arms) were included in the study. A coordinate system originating at the medial epicondyle was established, with the y-axis running to the axillary apex and expressed in relative value. The y-axis was trisected and each third from proximal to distal were designated as A, B, and C, respectively. Based on this, the medial arm flap was used to reconstruct defects in the head and neck, hand, axilla, elbow and chest wall.@*Results@#An average of 4.6 perforators were identified along the medial intermuscular septum of the arm, located at 0.87±0.08, 0.50±0.09 and 0.20±0.06 on the y-axis, with a prevalence of 95.6%, 100% and 86.7%, respectively. Among the 45 flaps, 30 were used as pedicled distant flaps and 15 as perforator-based propeller flaps, with an average size of 18.7 cm×8.1 cm. The average length of the perforator pedicle was 3.1 cm. One pedicled distant flap developed hematoma after pedicle division but recovered with hematoma removal. One perforator-based propeller flap had partial loss of the distal third, requiring surgical debridement followed by a local flap transfer. Two perforator-based propeller flaps had venous congestion but survived completely with conservative therapy. The remaining flaps healed uneventfully. Donor-site morbidity was minimal. The patients were followed up for 6 months to 3 years (average 12.6 months) with satisfactory aesthetic appearance, greatly improved function and no tumor recurrence.@*Conclusions@#The constant perforators could be found in each third of the medial arm. The perforator-based medial arm flap could be used for various soft-tissue defect reconstructions.