title: Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application.
abstract: BACKGROUND
  Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow.
  
  
  METHODS
  Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators.
  
  
  RESULTS
  A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months.
  
  
  CONCLUSIONS
  The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction.
  
  
  CONCLUSIONS
  The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France UMR E-4320 MATOs CEA/iBEB/SBTN-CAL, Université Nice Sophia Antipolis, Faculté de Médecine, Nice, France camuzard.olivier@hotmail.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Camuzard
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Foissac
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Clerico
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Balaguer
authors.affiliation: Service de Chirurgie Oncologique Réparatrice, CAL, Nice, France.
authors.forename: Tarik
authors.initials: T
authors.lastname: Ihrai
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France.
authors.forename: Fernand
authors.initials: F
authors.lastname: de Peretti
authors.affiliation: Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Baqué
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Georgiou
authors.affiliation: Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bronsard
mesh_terms: D001158:Arteries / Q000033:anatomy & histology*; D002102:Cadaver; D004210:Dissection; D004550:Elbow / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap; D019651:Plastic Surgery Procedures