Distal Brachial Artery Perforator: An Anatomic Study

The medial upper arm is a potential donor site for the perforator flaps because of its ideal thickness, pliability, excellent color, and well-hidden donor site scar. Its main vascular supply originates from the cutaneous perforators of the superior ulnar collateral artery and brachial artery. The purpose of this cadaveric study was to localize and describe the characteristics of the distal brachial artery perforator (DBAp), which supplies the distal medial upper arm, thereby providing databases for flap elevation.

A cross-sectional study was carried out in 24 intact upper limbs from 12 fresh cadavers (6 men, 6 women). The surgical procedure was performed through 3 stages to locate the DBAp and then gather anatomical characteristics.

We always identify at least 1 DBAp in each arm. There were 30 perforators (mean number 1.25 ± 0.53). The average external diameter and length of perforator arteries were 0.95 ± 0.22 mm and 3.52 ± 1.29 cm, respectively. The majority of the points where the perforators pierce the deep fascia were spotted within a circle of 3.45 cm diameter, the center of which was 2.82 cm proximal (y value) and 1.40 cm lateral (x value) to the medial epicondyle. A consistent branch of the medial antebrachial cutaneous nerve (MACN) was found supplying sensory innervation to the DBAp flap.

The DBAp flap is a viable option for reconstructing soft tissue defects in the elbow and regions such as the face, head, and neck.