Medial Distal Arm Perforator Flap for elbow Soft Tissue Defects: A Cadaveric Study

A cadaveric anatomical study was performed on seven fresh adult upper limbs to assess the technical feasibility and reproducibility of a medial distal arm perforator flap for coverage of elbow soft-tissue defects. A theoretical 5-cm-diameter circle, corresponding to the flap skin-paddle width, was centered 7.5 cm proximal to the medial epicondyle on an axis joining the epicondyle to the mid-axillary fossa; this central point defined the flap pivot, and flap length was adjusted to match simulated elbow defects. Between two and five skin perforators were identified within the circle per limb. Perforator origin was from the brachial artery in 54% of specimens and from the superior ulnar collateral artery in 46%. Median distance from perforators to the medial epicondyle was 8.0 cm (range 7.0-9.0 cm). Median perforator diameter was 0.65 mm (range 0.5-0.9 mm). All simulated defects at the medial epicondyle, distal biceps tendon, and olecranon were coverable; median flap lengths required were 12.5 cm (12.5-13.5 cm), 15.0 cm (15-15 cm), and 16.0 cm (15.5-16.5 cm), respectively. Coverage of the lateral epicondyle was achieved in 6 of 7 limbs with a 17-cm flap. These findings indicate that the medial distal arm perforator flap is a reliable, reproducible option for elbow skin defects, providing an effective alternative to conventional flaps without sacrifice of major arteries. A standardized flap design is proposed, specifying a reproducible pivot point, a defined flap width, and clear distal and proximal boundaries. LEVEL OF EVIDENCE: IV.