Anatomical basis of the posterior brachial skin flap

The posterior brachial flap is a vascularized skin flap originally developed by AC Masquelet in 1982. Anatomical study in 37 non embalmed cadavers demonstrated the value of this flap which is taken from the posterior surface of the arm. The artery of the flap originates from the brachial or deep brachial artery and was present in all 37 subjects studied. This artery traverses the aponeurosis of the triceps brachii near the termination of the tendon of the teres major. The pedicle showed a mean length of 4.4 cm and mean diameter of 1.5 mm thus allowing satisfactory microsurgical anastomosis to be done. The mean length of the artery in the subcutaneous tissue was 11 cm. Venous return is via satellite veins. Sensory innervation of the flap is supplied by the nervus cutaneous brachii posterior, the first branch of the radial nerve. The posterior brachial flap can be used as a free flap. Owing to its innervation, this flap is appropriate for repair of defects in zones requiring sensory innervation. This flap can also be used as a pedicle flap for cutaneous repair of the axilla.