Cutaneous perforators of the upper arm and clinical applications

The authors investigated the distribution of constant cutaneous perforators in the upper arm. A total of 20 amputated upper arms of 10 fresh Korean cadavers were used for the study. Red latex was injected into the axillary arteries of ten specimens and lead oxide-gelatin mixture (radiopaque material) in the other ten. The cutaneous perforators were then identified by dissection and radiography. The upper arm had several (range: 5.7 to 6.3) perforating arteries in the subfascial plane, but only four fasciocutaneous perforators were constant: one in the medial intermuscular septum and three in the lateral intermuscular septum. The constant medial perforators were included in a circle of 2.89 cm in diameter, the center of which was 8.9 cm above and 1.2 cm medial to the medial epicondyle. The mean length and diameter of the extended pedicle of the medial perforator was 2.78 cm and 0.94 mm, respectively. The lowermost constant lateral perforators were included in a circle of 2.44 cm in diameter, the center of which was 16.8 cm above and 0.5 cm medial to the lateral epicondyle. The mean length and diameter of the extended pedicle of the lateral perforator was 2.88 cm and 0.84 mm, respectively. A flap based on the perforator of the medial intermuscular septum is not as simple as with the lateral intermuscular perforator, but direct closure of the donor site is more favorable. It is safe to design a free skin flap with knowledge of its dominant perforator.