THE BLOOD-SUPPLY OF THE DELTOID MUSCLE - APPLICATION TO THE DELTOID FLAP TECHNIQUE

The major ruptures of the rotators cuff point out the problem of their surgical repair. Various techniques are described in the literature, among them the deltoid nap technique, described by Apoil and Augereau. This technique points out the problem of a few cases of flap early ne crosis (Saragaglia). We studied the deltoid arterial blood supply on 4 0 cadaveric shoulder, after coloured injection into the subclavian art ery. Our study included 40 macroscopic and 15 radiographic observation s. The thoracoacromial artery gave off two collaterals to the anterior part of the deltoid muscle. The first one, called the deltoid artery, ran into the anterior part of the deltoid, near the deltopectoral lin e. In 53%, it gave off a first superior collateral branch, which ran a t 3 cm under the clavicle. The second one, called the acromial artery, ran deep to the anterior part of the deltoid muscle, near the clavicl e and the acromion. The posterior circumflex humeral artery was the mo st important artery. It supplied the posterior and middle parts of the deltoid muscle. The anterior circumflex humeral artery supplied the a nterior part of the deltoid muscle in 63%. In ten cases, we dissected a deltoid flap. In all the cases, the acromial artery was cut near the acromion. When the deltoid artery gives off its superior collateral b ranch, it was always cut. Then, this flap was only vascularized by its inferior aspect. These results show that the flap is located in a poo rly supplied area. Thus, the flap necrosis could be explained by an in sufficient anastomotic network. An operative technique modification co uld avoid this complication.