ALTERNATIVE USE OF MEDIAL AND POSTERIOR UPPER-ARM FLAPS

There are such marked variations in the vascular anatomy of the nutrie nt vessels in medial and posterior upper arm flaps, that widespread us age of these flaps has been delayed. The authors have evaluated both m edial and posterior upper arm flaps and have concentrated on the statu s of the skin perforators. Both types of flaps were considered for use as free transfers in 25 cases; island flaps were successfully elevate d in 22 patients (11 medial and 11 posterior flaps). Because of the la ck of suitable perforating vessels, this solution was abandoned in thr ee patients. Perforators in both areas were found in 44 percent of the cases, in one or the other area in 44 percent, and not at all in 12 p ercent of the cases. Using the determination of perforators, the succe ss rate of free-flap transfers from the medial and posterior upper arm increased from 64 and 68 percent, respectively to 88 percent. When ha rvesting a flap from the medial or posterior upper arm, the risks atte nding questions of vascular stability in free-flap transfer, may be ov ercome by clinician experience.