Use of medial arm skin as a free flap.
BACKGROUND
Free transfer of the medial arm flap has not gained popularity despite the hidden donor-site scar as well as the hairless and elastic skin. This may be because of variations in vascular anatomy, leading to confusion during dissection of the flap.


METHODS
In five preserved cadaver arms, the vascular pattern of medial arm skin was examined. Twenty-two upper extremity angiograms were examined, and 12 free medial arm flaps were elevated for various defects in 12 patients.


RESULTS
In cadaver and clinical dissections, the authors found that blood supply to the flap is multiple: from the superior ulnar collateral artery, the direct cutaneous artery, or both. A superficial brachial artery may also be present, which was observed in four angiograms and two clinical cases (15 percent). Dissections showed that the medial arm skin may be elevated based on the superficial brachial artery, direct cutaneous artery, or superior ulnar collateral artery. A neurosensory flap may be obtained by including the medial brachial cutaneous nerve of the arm.


CONCLUSIONS
A medial arm free flap is a plausible reconstructive option with good knowledge of the anatomical variations, as the defect on the medial arm is cosmetically more acceptable and has a better color match for head and neck reconstructions.
Karamürsel
Sebat
S
Plastic Surgery Clinic, Ankara Social Insurance Hospital, Department of Anatomy, Ankara University, Ankara, Turkey.
Bağdatli
Dilek
D
Demir
Zühtü
Z
Tüccar
Eray
E
Celebioğlu
Selim
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000601:surgery; D001366:Axillary Artery / Q000033:anatomy & histology; D001916:Brachial Artery / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply; D020858:Tissue and Organ Harvesting; D017535:Ulnar Artery / Q000033:anatomy & histology; D014459:Ulnar Nerve / Q000098:blood supply