title: Anatomic study of the flexor carpi ulnaris muscle and its application to soft tissue coverage of the elbow with clinical correlation.
abstract: BACKGROUND
  The posterior elbow is prone to soft tissue loss that may require reconstructive methods for wound healing to be achieved. The flexor carpi ulnaris (FCU) muscle has been described for coverage in case reports and small series. Previous studies give conflicting anatomic findings about the dominant vascular pedicle for the FCU.
  
  
  METHODS
  Twenty-five cadaveric specimens were dissected. Pedicle location, number, and distance from the medial epicondyle were recorded along with the extent of posterior elbow coverage. Chart review was conducted during a 4-year period. Eight patients who underwent FCU rotational flap coverage were identified. Those flaps relied entirely on a single proximal pedicle.
  
  
  RESULTS
  The vascular pedicles from the ulnar artery or recurrent ulnar artery were identified in 24 of 25 specimens. The average distance from the tip of the medial epicondyle to the first pedicle was 5.7 cm (range, 3 to 10 cm). The length of muscle coverage proximal to the olecranon tip averaged 9.3 cm. The clinical follow-up of 7 patients requiring FCU rotational flaps for coverage of the posterior elbow showed that all flaps survived and provided adequate coverage for the defect.
  
  
  CONCLUSIONS
  The FCU rotational pedicle flap provides predictable coverage of small to medium-sized defects about the posterior elbow. Although it is relatively consistent, the proximal vascular pedicle does demonstrate some variability, which should be considered in planning surgery. The consistent distal extent of the FCU muscle belly provides wider proximal coverage of defects.
authors: Southern California Permanente Medical Group, Fontana, CA, USA.
authors: Frances
authors: F
authors: Sharpe
authors: Department of Orthopedics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
authors: Piers
authors: P
authors: Barry
authors: Department of Orthopedics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
authors: Steven D
authors: SD
authors: Lin
authors: Department of Orthopedics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA. Electronic address: stevanovic@usc.edu.
authors: Milan
authors: M
authors: Stevanovic
mesh_terms: D000328:Adult; D000368:Aged; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects; D002102:Cadaver; D004550:Elbow / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000601:surgery*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D000092464:Elbow Injuries
keywords: Case Series; Elbow; Level IV; Treatment Study; flexor carpi ulnaris; soft tissue coverage; vascular anatomy