“Forearm Based Turnover Muscle Flaps for Elbow Soft Tissue Reconstruction: A Comparison of Regional Coverage Based on Distal Flap Perfusion.”

Background: Elbow wounds pose a reconstructive challenge. Prior studies have described the vascular anatomy of both the brachioradialis (BR) and flexor carpi ulnaris (FCU) muscle flaps. The goal of this study was to describe the distal flap perfusion of the flexor carpi radialis (FCR), with a direct comparison of the BR, FCU, and FCR muscle flaps for coverage around the elbow. Methods: Six fresh-frozen upper extremity specimens were dissected for BR, FCR, and FCU flaps. Vascular data from prior studies was combined with our anatomical measurements to determine the area of perfused coverage around the elbow for the BR and FCU. The FCR flap distal vascular perfusion was separately examined with transverse sections at 1 cm intervals after India-ink injections to determine distal flap perfusion and elbow coverage. Perfusion data was plotted on an x- and y-axis over the posterior elbow. Results: The BR muscle covered an average of 56% of the x-axis and 7.4% of the y-axis. The FCU muscle covered an average of 90% of the elbow along the x-axis and 23.3% of elbow along the y-axis. Based on our perfusion data, the FCR covered an average of 34% of the x-axis and 4.8% of the y-axis. Conclusion: The FCU muscle provides the most versatile and robust coverage over the posterior elbow, followed by the BR muscle which consistently provides coverage over the lateral epicondyle. The FCR may be used in select cases for lateral epicondyle coverage and may be considered as a secondary option. Presented at the 71st Annual Meeting for the American Society for the Surgery of the Hand in Austin, Texas, from September 29 to October 1, 2016; Annual Meeting for American Association for Hand Surgery in Waikoloa, Hawaii, from January 11 to January 14, 2017. Financial Disclosure Statement: Financial support for this study was provided from funds awarded through the Piedmont Orthopedic Society Research Grant (https://ift.tt/2GVPRmi). Corresponding Author: Yash J. Avashia, MD, Division of Oral, Maxillofacial, and Plastic Surgery, Duke University Medical Center, 40 Duke Medicine Circle, M150, Green Zone, DUMC 2824, Durham, NC 27710, Email Address: yja@duke.edu ©2018American Society of Plastic Surgeons

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