Revisiting vascular and venous drainage of lateral arm flap from anatomy
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LETTER TO THE EDITOR
Revisiting vascular and venous drainage of lateral arm flap from anatomy Fang Yu1 · Juyu Tang1 Received: 22 February 2020 / Accepted: 27 April 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
The lateral arm flap has become one of the most commonly used free skin flaps for coverage of small- and moderatesized defects, with advantages such as reliable and constant anatomy, low morbidity at the donor site and combination of various tissue components. Recently, Zinon et al. have performed a review of lateral arm flap, where they mentioned that “anterior radial collateral artery (ARCA) is not suitable to provide the basis of the flap because of its variation and the proximity of the radial nerve,” and “a superficial venous system drains into the deep veins as well as into the cephalic vein, which courses through the anterior region of the LAF area, emptying into the axillary vein [1].” However, in our opinion, these statements misunderstood the vascular anatomy of lateral arm flap. The radial collateral artery (RCA) originates on the posterior aspect of the humerus from the profunda brachii artery. Before meeting lateral intermuscular septum (LIS), it splits into the small ARCA and the stronger posterior radial collateral artery (PRCA). PRCA courses distally within LIS and ultimately anastomoses with the radial recurrent artery and interosseous recurrent artery with small caliber vessels around the lateral epicondyle [2]. Along this course, it gives off 4 to 5 septocutaneous perforators nourishing the lateral arm skin, which supports the lateral arm flap elevation. ARCA pierces LIS and accompanies the radial nerve between the brachialis and brachioradialis muscles. Hennerbichler found that, near the bifurcation of the RCA, there is a septocutaneous branch originated from the ARCA only in 2 out of 24 cadaver arms, and distal to this septocutaneous branch, ARCA sends no additional branches to the lateral arm flap, but provides branches to the adjacent muscles and
radial nerve [3]. ARCA has fewer fasciocutaneous and more muscular branches than the PRCA [4]. Therefore, instead of anatomy variation, lacking of septocutaneous branch to lateral arm skin is the exact reason that ARCA is not suitable to provide the basis of the flap. Two main venous systems are present in lateral arm flap area: the deep venous system and the subcutaneous network. Deep venous drainage is provided by the paired venae comitans of PRCA with large diameter (average 2.8 mm) [2], which were used to anastomose. Clinically, the only deep venous anastomosis is absolutely enough to drain the flap. Some authors mentioned the cephalic vein as the venous drainage of flap. However, the surficial venous system drains blood from lateral arm to cephalic vein via small superficial veins, which are difficult to anastomose during transplantation. Furthermore, the cephalic vein mostly runs at the medial side of upper arm, which is too far away from the lateral side [5]. In 1986, Inoue and Fujino reported a case of the upper arm
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