In the field of reconstructive surgery, the skin flap has played a major role and is continuously developing. The free flap transfer has been used easily with the advent of microvascular surgery. The reconstruction of hand or foot require particular prerequisites such as thin and even flap containing nerve and bone.
Since Song(1982) had reported the forearm and upper arm flap, a few clinical experience on upper arm flap has been reported. The upper arm flap was suggested as one of better flap donor sites which satisfies the above mentioned requirements. However, neither the general anatomy textbooks mention about the distribution of upper arm blood vessel in detail nor any domestic reports are available.
We observed and analysed the origin and pathway of the deep brachial artery, radial collateral branch(R.C.B.) of deep brachial artery, vena comitans of R.C.B., their diameters at various points, skin flap territories upon dye injection in R.C.B., relationship between R.C.B. and radial nerve, pathway of posterior upper arm cutaneous nerve, by the dissection of 27 adult Korean cavaders(25 : bilateral, 2 : unilateral) and the distance between lateral intermuscular septum and lateral epicondyle was measured from 30 male Korean doctors of Severance Hospital.
The results were summerized as follow:
1. Deep brachial artery arose alone from brachial artery in 27 cases(52%), arose from the brachial artery with the superior ulnar collateral branch in 16 cases(30%) and directly from axillrya a. in 4 cases(8%). The diameter at the origin of deep brachial artery was 2.2±0.37mm in average. (range 1.5∼2.7mm)
2. Deep brachial artery wound posteriorly in the spiral groove of the humerus deep to triceps muscle and entered the depths of the lateral intermuscular septum between the deltoid insertion anteriorly and the triceps muscle posteriorly. Radial collateral branch of deep brachial artery proceeded distally in the lateral intermuscular septum between triceps posteriorly and brachialis and brachioradialis muscle anteriorly.
3. The diameters at its pathway of R.C.B. were 1.5±0.27mm(proximal) 1.0±0.29mm(middle), 0.75±0.15mm(distal) in average.
4. The diameter of R.C.B. was bigger in male than in female and right side was also bigger than left.
5. The number of cutaneous branch of R.C.B. was 3.6±0.6 in average.(range3∼5)
6. Diameters of vena comitans of R.C.B. was 1.7±0.20mm(range: 1.2∼2.0mm)
7. Posterior cutaneous nerve of upper arm and foream runs along the R.C.B. but only 34 cases(65%) distributed upper arm exclusively.
8. The cutaneous territory after 2% methylene blue injection in R.C.B. was 8×12cm and long axis of territory was parallel to axis of limb.
9. The distance between ateral intermuscular septum and latleral epicondyle in living adult male was 13.2±0.42cm. (range: 12.5∼14.5cm)
10. Considering above results, the introduction of lateral upper arm flap based on R.C.B. may be an useful adjunct for reconstruction of hand or foot.
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