Vascular anatomy of the brachioradialis rotational musculocutaneous flap

The purpose of this 2-part vascular injection study was to (1) determine th e sources of blood supply to the brachioradialis muscle and the distance ar ound which the brachioradialis muscle flap may be rotated for local sort ti ssue reconstruction and (2) determine the fasciocutaneous vascular perfusio n territory associated with the vascular pedicle of the brachioradialis mus cle flap. Lead oxide injections were administered in 16 fresh frozen human upper extremity amputation specimens to determine the contribution of the i solated radial recurrent artery (RRA) and subsequent 3- and 6-cm segments o f radial artery (RA) to a rotational brachioradialis muscle flap. The RRA p erfused an average of 41 % (range, 20% to 60%) of the brachioradialis muscl e length. Selective injection of the RRA and the proximal 3-cm segment of t he RA perfused 80% (range, 59% to 100%) of the muscle length, corresponding to more than 90% of muscle volume. Flap rotation consistently provided ade quate tissue coverage to the antecubital fossa, the lateral elbow, and the proximal one-third volar forearm. Based on these findings, the fasciocutane ous perfusion territory of the isolated vascular pedicle was quantified by selective India ink injection studies in 10 fresh frozen cadaveric specimen s. Consistent fasciocutaneous perfusion occurred directly over the muscle b elly. No specimen, however, was perfused greater than approximately 1 cm di stal to the musculocutaneous junction. This 2-part study defines the vascul ar anatomy and local utility of the brachioradialis rotational musculocutan eous flap. Copyright (C) 2001 by the American Society for Surgery of the Ha nd.