title: Vascular territories of the medial upper arm-an anatomic study of the vascular basis for individualized flap design.
abstract: Fasciocutaneous flaps supplied by discrete perforator arteries can be raised in numerous parts of the human body and are routinely used in plastic surgery. The aim of this anatomical investigation was to provide a description of the vascular supply of the medial upper arm, to localize and measure the perforator arteries and to define potential perforator flap dimensions in pendency of individual anatomical conditions.
  
  
  
  A total of 20 upper limbs from 11 fresh cadavers were examined. The brachial arteries were exposed and the medial perforator arteries selectively injected with methylene blue and india ink in an alternating sequence. The size of the angiosomes, the diameter and length of the perforators' pedicles and distances between the arteries and the medial epicondyle and apex of the axilla respectively were measured.
  
  
  
  On average, 4.55 ± 1.47 perforating arteries arose from the brachial artery and it's medial off branching arteries. Their mean diameter was 0.68 ± 0.27 mm and their pedicles had an average length of 3.62 ± 1.61 cm measured from suprafascial until arborisation. In 80% the first proximal perforator was present in an area of 4 cm radius at centre coordinates of (20/2). A constant distal perforator was found within a circle of 3 cm radius, of which the centre had the coordinates (8/1). The average size of the angiosomes was 121.1 ± 58.5 cm2. Direct branches of the brachial artery feed circular shaped vascular territories, whereas superior ulnar collateral arteries (SUCAs) feed oblong shaped territories.
  
  
  
  This anatomical study provides valuable data of the medial arm flap in order to be applied clinically. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Plastic and Reconstructive Surgery Department of Surgery, Medical University of Vienna, Austria.|Center for Anatomy and Cell Biology Medical University of Vienna, Austria.
authors.forename: Ines E
authors.initials: IE
authors.lastname: Tinhofer
authors.affiliation: Division of Plastic and Reconstructive Surgery Department of Surgery, Medical University of Vienna, Austria.
authors.forename: Chieh-Han
authors.initials: CH
authors.lastname: Tzou
authors.affiliation: Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Austria.|Department of Plastic Surgery and Hand Surgery, Technical University Munich, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Duscher
authors.affiliation: Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Austria.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pollhammer
authors.affiliation: Center for Anatomy and Cell Biology Medical University of Vienna, Austria.
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Weninger
authors.affiliation: Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Austria.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Huemer
authors.affiliation: Section of Plastic, Aesthetic and Reconstructive Surgery, Kepler University Hospital Linz, Austria.
authors.forename: Manfred
authors.identifier: 0000-0001-8220-8419
authors.initials: M
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000033:anatomy & histology / Q000098:blood supply*; D001916:Brachial Artery / Q000033:anatomy & histology* / Q000637:transplantation; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods; D017535:Ulnar Artery / Q000033:anatomy & histology* / Q000637:transplantation
keywords: anatomy; medial upper arm flap; perforator flap; reconstruction; superior ulnar collateral artery