Vascular Perfusion of a Flexor Carpi Ulnaris Muscle Turnover Pedicle Flap for Posterior Elbow Soft Tissue Reconstruction: A Cadaveric Study

Abstract

The use of a pedicled flexor carpi ulnaris (FCU) muscle proximal turnover flap has been described previously for soft tissue reconstruction at the posterior elbow. Whereas consistent arterial supply to the FCU has been reported, the reliability of distal flap perfusion has not been confirmed. This study evaluated the vascular perfusion of an FCU turnover flap, based on the most proximal primary vascular pedicle that would permit a proximal turnover flap reconstruction to include the olecranon tip. In 12 fresh-frozen, proximal humeral human amputation specimens, the FCU flap was elevated from distal to proximal, preserving the most proximal primary vascular pedicle to the muscle belly that would permit flap coverage of the olecranon tip. The axillary artery was injected with India ink after ligation of radial and ulnar arteries at the wrist. After injection, each specimen was sectioned transversely at 0.5-cm increments to assess vascular perfusion of the muscle using loupe magnification. The distance from the olecranon tip to the distal FCU muscle belly was 25.9 cm. The primary vascular pedicle that would facilitate creation of a proximal turnover flap was, on average, 5.9 cm distal to the olecranon tip. Perfusion of FCU muscle as measured distal to this primary pedicle was present in 50% to 100% of the muscle belly at an average of 8.9 cm beyond the pedicle. Perfusion of 25% to 50% of the FCU muscle belly was present at an average of 11.1 cm beyond the pedicle. Perfusion became less consistent (<25%) within the muscle belly at an average distance of 11.6 cm. Use of a proximally based, pedicled FCU muscle turnover flap provides a reliable option for soft tissue reconstruction at the posterior elbow. We observed consistent arterial perfusion of the muscle flap when preserving a proximal vascular pedicle 5.9 cm distal to the olecranon tip.