Anatomy of upper extremity skin flaps

The design of upper extremity skin flaps is determined by the anatomy and hemodynamics of each donor site. Skin flaps are best characterized by their blood supply into three types--the direct cutaneous, musculocutaneous, and septocutaneous. Because of the predominance of the septocutaneous vascular system in the upper extremity, the majority of useful flaps in that area are derived from this system. Knowledge of the regulatory factors of the cutaneous circulation is critical in understanding the hemodynamic changes associated with flap elevation if the flap is to be successful. By combining careful flap design based on a knowledge of vascular anatomy and the appropriate postoperative regimen, survival of flaps may be increased significantly.