Vascular anatomy of the brachioradialis rotational musculocutaneous flap.

Abstract

The purpose of this 2-part vascular injection study was to (1) determine the sources of blood supply to the brachioradialis muscle and the distance around which the brachioradialis muscle flap may be rotated for local soft tissue reconstruction and (2) determine the fasciocutaneous vascular perfusion territory associated with the vascular pedicle of the brachioradialis muscle flap. Lead oxide injections were administered in 16 fresh frozen human upper extremity amputation specimens to determine the contribution of the isolated radial recurrent artery (RRA) and subsequent 3- and 6-cm segments of radial artery (RA) to a rotational brachioradialis muscle flap. The RRA perfused an average of 41% (range, 20% to 60%) of the brachioradialis muscle length. Selective injection of the RRA and the proximal 3-cm segment of the RA perfused 80% (range, 59% to 100%) of the muscle length, corresponding to more than 90% of muscle volume. Flap rotation consistently provided adequate tissue coverage to the antecubital fossa, the lateral elbow, and the proximal one-third volar forearm. Based on these findings, the fasciocutaneous perfusion territory of the isolated vascular pedicle was quantified by selective India ink injection studies in 10 fresh frozen cadaveric specimens. Consistent fasciocutaneous perfusion occurred directly over the muscle belly. No specimen, however, was perfused greater than approximately 1 cm distal to the musculocutaneous junction. This 2-part study defines the vascular anatomy and local utility of the brachioradialis rotational musculocutaneous flap.