Avoiding the medial brachial cutaneous nerve in brachioplasty: an anatomical study

With more patients undergoing bariatric surgery procedures, there has been an increased demand on plastic surgeons to manage excess skin around the body from massive weight loss. The upper arm is one of the areas that require surgical attention. One of the complications of brachioplasty is injury to cutaneous nerves of the arm. We report our findings of the location of the medial brachial cutaneous nerve on the basis of anatomical landmarks to aid the reconstructive surgeon in planning his or her operative approach and procedure.

Eight fresh cadaver arms were dissected under loupe magnification. The brachial plexus was dissected from proximal to distal to evaluate the branching points of the cutaneous nerves. Measurements were taken from the medial epicondyle to cutaneous branches off the main nerve.

At about 7 cm proximal to the medial epicondyle, there is an arborization of 2 to 3 cutaneous branches. This nerve sends 3 to 4 branches through the muscular fascia across the ulnar nerve to skin of the medial arm at about 15 cm proximal to the medial epicondyle. In most cadavers, this was found in the midportion of the arm.

The plastic surgeon will be challenged to effectively manage excess skin from weight loss. Placing the incisions more posteriorly on the arm will help avoid morbidity associated with injury to these nerves, while still providing an acceptable aesthetic outcome. Knowledge of the anatomy of the course of the medial brachial cutaneous nerve can help the surgeon better plan his or her operative approach to maximize aesthetic benefit and limit nerve injury.