The antecubital fascio-cutaneous flap

doi:10.1016/0007-1226(83)90122-4

British Journal of Plastic Surgery

Volume 36, Issue 4, October 1983, Pages 428-433

https://doi.org/10.1016/0007-1226(83)90122-4 Get rights and content

Abstract

A clinical case is reported in which a fascio-cutaneous forearm pedicled flap was used. The flap was based on the previously described inferior cubital artery. Anatomical studies suggested that this vessel could be the basis for a fascio-cutaneous free flap possessing an exceptionally long vascular pedicle. This flap is described and its implications discussed in relation to the radial forearm (Chinese) flap.

Reference (4)

SoutarD.S. et al.
The radial forearm flap: a versatile method of intra-oral reconstruction
British Journal of Plastic Surgery
(1983)
LambertyB.G.H. et al.
The forearm angiotomes
British Journal of Plastic Surgery
(1982)

There are more references available in the full text version of this article.

Cited by (87)

Vascularization of the lateral and medial antebrachial cutaneous nerves by cutaneous perforator arteries: An anatomical study
2021, Hand Surgery and Rehabilitation
Citation Excerpt :
Regarding LABCN vascularization, we found in all dissected specimens that a cutaneous perforator artery—the proximal radial perforator artery (also called the inferior cubital artery perforator)—provides branches for nerve and skin vascularization. This artery, first described by Lamberty and Cormack, is a constant artery found in the proximal third of the anterior forearm, with a mean diameter of 1 mm and a mean length of almost 40 mm [27–29]. The origin of this artery is 35 ± 5 mm distal to the midpoint of the interepicondylar line on the anterior aspect of the forearm on the medial side of the brachioradialis muscle [27,29].
The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5 mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.
L’avant-bras est un site donneur intéressant de greffe nerveuse non vascularisée. Très peu d’études se sont intéressées à l’utilisation des nerfs cutanés latéral et médial de l’avant-bras (NCLAB et NCMAB) comme potentielle greffe nerveuse vascularisée (GNV). L’objectif de cette étude anatomique était d’analyser les caractéristiques et la vascularisation de ces nerfs afin de décrire de nouveaux sites de GNV. Douze avant-bras ont été disséqués à partir de cadavres fraîchement injectés de latex rouge. Le nombre de branches terminales, la longueur et les diamètres proximaux et distaux des NCLAB et NCMAB ont été étudiés. Les caractéristiques anatomiques des artères perforantes cutanées des artères radiale et ulnaire qui vascularisent ces nerfs sont également rapportées: nombre d’artère perforantes, longueur, type (septo- ou musculo-cutané) et localisation dans la région de l’avant-bras (tiers proximal, moyen et distal). Dans plus de 80% des cas, les artères perforantes cutanées de l’artère radiale ou ulnaire participaient à la vascularization des NCLAB et NCMAB respectivement. Ces artères, situées pour la plupart dans le tiers proximal de l’avant-bras, avaient un diamètre > 0,5 mm et provenaient des artères radiale (NCLAB) et ulnaire (NCMAB). Dans plus de 75% des cas, ces artères vascularisaient également les veines superficielles et la peau. Nous avons observé que ces nerfs sensitifs superficiels de l’avant-bras étaient vascularisés par des artères perforantes cutanées. Ces artères participent également à la vascularization des veines superficielles. Au total, cette étude anatomique indique que les chirurgiens reconstructeurs pourraient utiliser de nouveaux nerfs vascularisés basés sur les artères perforantes de l’avant-bras.
Arterial grafts for proper palmar digital artery reconstruction: An anatomical study
2021, Hand Surgery and Rehabilitation
Citation Excerpt :
In our dissections, a constant large perforator was located proximally on the radial artery. This perforator is the proximal radial perforator artery that has been described in previous studies [18,26,27]. The origin of this artery is 35 ± 5 mm distal to the midpoint of the interepicondylar line on the anterior aspect of the forearm on the medial side of the brachioradialis muscle, and at the level of the inverted V formed by the radial branch of the cephalic vein and the communicating vein.
Digital ischemia due to arterial defects need urgent surgical management. The traditional treatment consists of vascular reconstruction using a reversed autologous venous graft as a bypass. Very few studies have described the use of arterial grafts for digital artery reconstruction. This cadaver study characterized the forearm perforator arteries to assess the potential feasibility of using them as donor grafts for digital artery reconstruction. Eleven forearms and twenty hands were dissected from freshly injected cadavers. All clinically significant perforators (>0.5 mm) derived from radial or ulnar arteries and digital arteries were evaluated. The digital palmar arteries were measured at three points: metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and distal interphalangeal (PIP) joint. In the 11 forearms analyzed, 5.5 ± 1.3 perforators from radial or ulnar arteries with a diameter of at least 0.5 mm were found per dissection. The mean diameters were 0.9 ± 0.18 mm proximally and 0.8 ± 0.15 mm distally; the mean length was 35.6 ± 11.35 mm. The mean diameters for the dominant and non-dominant arteries were 1.5 and 1.3 mm at the MCP, 1.3 and 1.0 mm at the PIP, 0.8 and 0.7 mm at the DIP, respectively. The forearms are good donor sites as they have large-diameter arteries of suitable length for arterial grafting. These new arterial grafts may be suitable for vascular reconstruction of digital arteries starting from the PIP joint.
La dévascularisation digitale est une urgence chirurgicale et une situation complexe à prendre en charge. Ces réparations vasculaires entraînent souvent la réalisation de pontages et il est d’usage de prélever des greffons veineux. Très peu d’études ont été consacrées à l’intérêt de greffons artériels pour les artères de petit diamètre. L’objectif de notre travail était d’étudier les caractéristiques anatomiques des artères perforantes à destinée cutanée de l’avant-bras afin de décrire des greffons artériels pour la réalisation de pontage des artères digitales palmaires propres. Nous avons réalisé une étude anatomique sur 11 avant-bras. Les perforantes cutanées palmaires des artères radiale et ulnaire étaient repérées puis analysées. Nous avons mesuré leur longueur totale et leur diamètre, puis ces valeurs ont été comparées à celles des artères digitales palmaires propres. Sur les 11 avant-bras disséqués nous avons trouvé en moyenne 12 ± 4 perforantes provenant des artères radiale et ulnaire. Les diamètres moyens étaient de 0,9 ± 0,18 mm en proximal et de 0,8 ± 0,15 mm en distal ; la longueur moyenne était de 35,6 ± 11,35 mm. Les diamètres des artères digitales palmaires propres mesuraient en moyenne 0,9 mm au niveau des articulations métacarpo-phalangiennes et 0,4 mm au niveau de l’articulation interphalangienne distale des doigts. Ces artères perforantes cutanées présentent un calibre proche des artères digitales palmaires propres. Ces artères sont donc un site donneur potentiel en cas de nécessité de greffon artériel pour la revascularisation des doigts.
Coverage of skin defect due to losses of substance in the elbow
2020, Annales de Chirurgie Plastique Esthetique
Citation Excerpt :
Ce lambeau a l’avantage d’être sensible par l’intermédiaire du nerf cutané latéral de l’avant-bras, son arc de rotation est grand. Le prélèvement peut se faire sous la forme d’une palette cutanée distale en îlot, ou péninsulaire ; le prélèvement peut-être fasciocutané comme l’on décrit Cormak et Lamberty [13], voire cutané pur [14]. L’artère du lambeau naît de l’artère radiale ou de la récurrente radiale, juste à leur origine, rejoignant le plan sous-cutané après avoir traversé le fascia antébrachial (elle est retrouvée à 4 cm sous le pli du coude par une incision médiane, sous le fascia) ; elle se dirige ensuite vers la styloïde radiale, selon une direction légèrement oblique, distribuant dans son trajet entre 4 et 7 rameaux cutanés ; l’artère s’épuise à 9,5 cm environ de son émergence.
Skin defects of the elbow follow severe trauma or bone exposure after skin necrosis, osteitis, or management of infected pseudarthrosis. The orthopedic and plastic management of these lesions is fundamental. The authors describe the different clinical frameworks that can lead to bone and/or joint exposure. Before, during or at a distance from bone management (external fixation, internal fixation, temporary cementoplasty, bone graft…), they detail the surgical techniques aimed at covering skin defects of the elbow. The authors review simple skin replacement techniques such as Z-plasties, emphasizing the interest of pedicled flaps of the arm and forearm, as well as muscle or fascio-cutaneous flaps, which are able to cover almost all the elbow skin defects.
Les pertes de substance cutanée du coude font suite à des traumatismes sévères ou à des expositions osseuses après nécrose cutanée, ostéite ou cure d’une pseudarthrose infectée. La prise en charge orthopédique et plastique de ces lésions est fondamentale. Les auteurs détaillent les différents cadres cliniques pouvant aboutir à une exposition osseuse et ou articulaire. Avant, pendant ou à distance du geste osseux (exo-fixation, fixation interne, cimentoplastie provisoire, greffe osseuse…), ils rappellent les procédés de couverture des pertes de substance cutanée. Ils passent en revue les techniques simples de remplacement cutané comme les plasties en Z en insistant essentiellement sur les lambeaux pédiculés du bras et de l’avant-bras, musculaires ou fasciocutanés, qui permettent de couvrir la quasi-totalité des défects du coude.
Soft Tissue Coverage of the Elbow
2018, Morrey's The Elbow and Its Disorders
The modified Lamberty and Cormack's flap for neuropathies of the ulnar nerve at the elbow
2013, Chirurgie de la Main
Le traitement chirurgical de la compression du nerf ulnaire au coude donne de bons résultats dans la majorité des cas, mais on observe parfois des résultats incomplets ou des récidives qui peuvent conduire à des interventions itératives. Cette chirurgie itérative entraîne des séquelles douloureuses neuropathiques résistant souvent aux traitements pharmacologiques. Dans ces cas rebelles sélectionnés, nous avons fait le choix d’un traitement chirurgical associant une neurolyse du nerf ulnaire avec enveloppement par le lambeau vascularisé de Lamberty et Cormack modifié. L’étude rétrospective a porté sur six cas avec un recul moyen de 30 mois. Les résultats montrent une amélioration de tous les patients, notamment pour les deux critères reflétant le mieux les douleurs neuropathiques : le questionnaire DN4 et l’échelle visuelle analogique de la douleur. Cette série, quoique courte, nous engage à continuer d’appliquer le principe de couverture des neuropathies du nerf ulnaire au coude par un lambeau vascularisé.
Surgical treatment of ulnar nerve syndrome at the elbow gives good results in the majority of cases but there are sometimes incomplete results or recurrences that can lead to iterative procedures. This iterative surgery is responsible for painful neurological sequelae often resistant to pharmacological treatments. In these selected resistant cases, we made the choice of a surgical treatment associating a neurolysis of the ulnar nerve and wrapping with a vascularized flap modified from Lamberty and Cormack. This retrospective study focused on six cases with an average follow-up of 30 months. The results showed an improvement in all patients, especially for the two criteria which best reflect the neuropathic pain: DN4 questionnaire and the visual analog scale of pain. Even if it is a short study, it commits us to continue to apply the principle of covering ulnar neuropathy at the elbow by a vascularized flap.
Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity
2013, Burns
Citation Excerpt :
In 1983, Soutar et al. first introduced the flow-through concept, which involved using a radial arterial flap in the reconstruction of the head and neck [18]. Then, Cormack and Lamberty used a fascio-cutaneous forearm pedicled flap in flow-through fashion [19]. In 1984, Foucher et al. first reported a flow-through compound radial artery forearm flap in reconstruction of the extremities [20].
Many surgeons have to face the challenge of the sophisticated management of catastrophic high-voltage injuries to upper extremities. These patients present with both vast soft tissue defects and varied segmental main artery defects with compromised circulation of the distal limb. This study is a first attempt to analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in acute electrical burns of the severely traumatized upper extremity.
From March 2001 to February 2012, five men were enrolled in the study. All in this series suffered from high voltage current (higher than 1000 V) electrical burn and had the presence of wide segmental soft tissue defects, exposure of underlying vital structures and segmental artery injury with compromised circulation. Flow-through anterolateral thigh flaps were used for limb salvage.
Follow up for all patients was present from 6 months to 7 years. The mean age was 37.8 years old. The mean timing of free flap transfer was 5.8 days after injury. The mean flap sizes were 31.6 cm × 16.5 cm. The mean artery defect was 14.2 cm in length. Venous thrombosis occurred 1 day post-operatively in one patient. No donor site morbidity was noted. In the postoperative period, no infection, no hematoma, nor deaths were noted. Successful limb salvage rate was 80% in this series.
In electrical injuries of the severely damaged upper extremity, flow through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously. Although the risk of flap failure is higher than with other etiologies of burn, the data shows that the above reconstruction technique is useful for upper extremity salvage.

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: This paper forms part of an essay entitled “Fascio-cutaneous Vessels” which was awarded joint First prize in the clinical category for the 1983 Scholarship Contest awarded by the Plastic Surgery Educational Foundation of the United States of America.

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The antecubital fascio-cutaneous flap

Abstract

British Journal of Plastic Surgery

The forearm angiotomes

British Journal of Plastic Surgery