Download PDF
J Reconstr Microsurg 2020; 36(07): 541-548
DOI: 10.1055/s-0040-1710551
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications

Thepparat Kanchanathepsak 
1   Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Chanakarn Rojpitipongsakorn
2   Department of Orthopaedics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samutprakan, Thailand
,
Tulyapruek Tawonsawatruk
1   Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Sorasak Suppaphol
1   Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Ittirat Watcharananan
1   Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Panithan Tuntiyatorn
2   Department of Orthopaedics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samutprakan, Thailand
› Author Affiliations
Further Information

Publication History

19 January 2020

11 April 2020

Publication Date:
14 May 2020 (online)

    Permissions and Reprints

Abstract

Background The neurocutaneous flap is an axial pattern flap that receives a vascular supply from a vessel along its cutaneous nerve and has favorable outcomes when used for soft tissue reconstruction in the upper extremities. The neurocutaneous flap depends on the lateral antebrachial cutaneous nerve (LACN) and its retrograde-flow has been studied via cadaveric dissection. The aim of this study is to prove the vascularity of the lateral antebrachial neurocutaneous (LABN) flap.

Methods The distally based LABN flap was created in 18 upper limbs (12 cadavers). The skin flap was dissected at the proximal half of the forearm and then diluted methylene blue was injected through the brachial artery. The pedicle of the flap on the distal half of the forearm was dissected along the LACN for the anatomical study of the perforating branches, paraneural vessels, and flap territory.

Results The mean age of cadavers was 74.1 years (nine males). The mean distance of most distal and proximal perforating branches from the radial styloid process were 2.32 ± 0.59 and 11.17 ± 1.72 cm, respectively. The mean total number of perforating branches was 7.4, which abundantly appeared approximately 4 to 5 cm from the radial styloid process. The mean flap territory was 8.64 ± 0.82 cm in width and 10.50 ± 1.90 cm in length. The mean forearm circumference was 24.84 ± 1.52 cm, and mean forearm length was 24.74 ± 1.8 cm.

Conclusion This study ensured that retrograde-flow via the neurocutaneous artery could be provided through the vascularity of the LABN flap, which suggests that the pivot point of the flap should not extend beyond 5 cm proximal to the radial styloid process. The LABN flap is a useful alternative method for performing soft tissue reconstruction in hand and wrist defects without sacrificing the major vessels.

Keywords

neurocutaneous flap - lateral antebrachial cutaneous nerve - paraneural vessels - distally based flap - retrograde-flow
 

  • References

  • 1 Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992; 89 (06) 1115-1121
    CrossrefPubMedGoogle Scholar
  • 2 Bertelli JA. Neurocutaneous axial island flaps in the forearm: anatomical, experimental and preliminary clinical results. Br J Plast Surg 1993; 46 (06) 489-496
    CrossrefPubMedGoogle Scholar
  • 3 Bertelli JA, Kaleli T. Retrograde-flow neurocutaneous island flaps in the forearm: anatomic basis and clinical results. Plast Reconstr Surg 1995; 95 (05) 851-859
    CrossrefPubMedGoogle Scholar
  • 4 Bertelli JA, Catarina S. Neurocutaneous island flaps in upper limb coverage: experience with 44 clinical cases. J Hand Surg Am 1997; 22 (03) 515-526
    CrossrefPubMedGoogle Scholar
  • 5 Nakajima H, Imanishi N, Fukuzumi S. , et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg 1999; 103 (01) 104-120
    CrossrefPubMedGoogle Scholar
  • 6 Ahmed SK, Fung BK, Ip WY, Fok M, Chow SP. The versatile reverse flow sural artery neurocutaneous flap: a case series and review of literature. J Orthop Surg Res 2008; 3: 15
    CrossrefPubMedGoogle Scholar
  • 7 Mak KH. Distally based sural neurocutaneous flaps for ankle and heel ulcers. Hong Kong Med J 2001; 7 (03) 291-295
    PubMedGoogle Scholar
  • 8 Vergara-Amador E. Distally-based superficial sural neurocutaneous flap for reconstruction of the ankle and foot in children. J Plast Reconstr Aesthet Surg 2009; 62 (08) 1087-1093
    CrossrefPubMedGoogle Scholar
  • 9 Zhong W, Lu S, Chai Y. Distally based saphenous neurocutaneous perforator flap: a versatile donor site for reconstruction of soft tissue defects of the medial malleolar region. J Foot Ankle Surg 2016; 55 (02) 391-396
    CrossrefPubMedGoogle Scholar
  • 10 Goil P, Choudhary GM, Jain R. , et al. Versatile distally based neurocutaneous saphenous flap in the era of microsurgery. Eur J Plast Surg 2018; 41 (02) 165-172
    CrossrefPubMedGoogle Scholar
  • 11 Dai J, Chai Y, Wang C, Wen G. Distally based saphenous neurocutaneous perforator flap for reconstructive surgery in the lower leg and the foot: a long-term follow-up study of 70 patients. J Reconstr Microsurg 2013; 29 (07) 481-485
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Dai J, Chai Y, Wang C, Wen G. Proximal-based saphenous neurocutaneous flaps: a novel tool for reconstructive surgery in the proximal lower leg and knee. J Reconstr Microsurg 2013; 29 (06) 373-378
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Dai J, Chai Y, Wang C, Wen G, Liu S, Zhang W. Comparative study of two types of distally based sural neurocutaneous flap for reconstruction of lower leg, ankle, and heel. J Reconstr Microsurg 2013; 29 (02) 125-130
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Zhang FH, Topp SG, Zhang WJ, Zheng HP, Zhang F. Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. Microsurgery 2006; 26 (05) 373-385
    CrossrefPubMedGoogle Scholar
  • 15 Wongkerdsook W, Agthong S, Amarase C, Yotnuengnit P, Huanmanop T, Chentanez V. Anatomy of the lateral antebrachial cutaneous nerve in relation to the lateral epicondyle and cephalic vein. Clin Anat 2011; 24 (01) 56-61
    CrossrefPubMedGoogle Scholar
  • 16 Im HS, Im JY, Kim KH, Kim DH, Park BK. Ultrasonographic study of the anatomical relationship between the lateral antebrachial cutaneous nerve and the cephalic vein. Ann Rehabil Med 2017; 41 (03) 421-425
    CrossrefPubMedGoogle Scholar
  • 17 Beldner S, Zlotolow DA, Melone Jr CP, Agnes AM, Jones MH. Anatomy of the lateral antebrachial cutaneous and superficial radial nerves in the forearm: a cadaveric and clinical study. J Hand Surg Am 2005; 30 (06) 1226-1230
    CrossrefPubMedGoogle Scholar
  • 18 Heymans OY, Nélissen XP, Peters S, Lemaire V, Carlier A. New approach to vascular injection in fresh cadaver dissection. J Reconstr Microsurg 2004; 20 (04) 311-315
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Doomernik DE, Kruse RR, Reijnen MM, Kozicz TL, Kooloos JG. A comparative study of vascular injection fluids in fresh-frozen and embalmed human cadaver forearms. J Anat 2016; 229 (04) 582-590
    CrossrefPubMedGoogle Scholar
  • 20 Bergeron L, Tang M, Morris SF. A review of vascular injection techniques for the study of perforator flaps. Plast Reconstr Surg 2006; 117 (06) 2050-2057
    CrossrefPubMedGoogle Scholar
  • 21 Xie A, Zhang J, Lu A. , et al. [Effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in treatment of hand defect]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28 (12) 1498-1501
    PubMedGoogle Scholar
  • 22 Ho AM, Chang J. Radial artery perforator flap. J Hand Surg Am 2010; 35 (02) 308-311
    CrossrefPubMedGoogle Scholar
  • 23 Page R, Chang J. Reconstruction of hand soft-tissue defects: alternatives to the radial forearm fasciocutaneous flap. J Hand Surg Am 2006; 31 (05) 847-856
    CrossrefPubMedGoogle Scholar
  • 24 Chang SM, Hou CL, Zhang F, Lineaweaver WC, Chen ZW, Gu YD. Distally based radial forearm flap with preservation of the radial artery: anatomic, experimental, and clinical studies. Microsurgery 2003; 23 (04) 328-337
    CrossrefPubMedGoogle Scholar
  • 25 Tiengo C, Macchi V, Porzionato A, Bassetto F, Mazzoleni F, De Caro R. Anatomical study of perforator arteries in the distally based radial forearm fasciosubcutaneous flap. Clin Anat 2004; 17 (08) 636-642
    CrossrefPubMedGoogle Scholar
  • 26 Karinja S, Riesel J, Iorio ML. Evaluating venous drainage in reverse flow pedicles: available evidence and mechanisms. J Reconstr Microsurg 2019; 35 (02) 90-96
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Imanishi N, Nakajima H, Fukuzumi S, Aiso S. Venous drainage of the distally based lesser saphenous-sural veno-neuroadipofascial pedicled fasciocutaneous flap: a radiographic perfusion study. Plast Reconstr Surg 1999; 103 (02) 494-498
    CrossrefPubMedGoogle Scholar
  • 28 Jing ZZ, Chang SM, You MR, Yu GR. Venous drainage in retrograde island flap: an experimental study using fluorescence tracing technique. Microsurgery 2010; 30 (01) 50-54
    CrossrefPubMedGoogle Scholar
  • 29 Higgins JP, Fisher S, Serletti JM, Orlando GS. Assessment of nerve graft donor sites used for reconstruction of traumatic digital nerve defects. J Hand Surg Am 2002; 27 (02) 286-292
    CrossrefPubMedGoogle Scholar
  • 30 Unal MB, Gokkus K, Sirin E, Cansü E. Lateral antebrachial cutaneous nerve as a donor source for digital nerve grafting: a concept revisited. Open Orthop J 2017; 11: 1041-1048
    CrossrefPubMedGoogle Scholar
  • 31 Poublon AR, Walbeehm ET, Duraku LS. , et al. The anatomical relationship of the superficial radial nerve and the lateral antebrachial cutaneous nerve: a possible factor in persistent neuropathic pain. J Plast Reconstr Aesthet Surg 2015; 68 (02) 237-242
    CrossrefPubMedGoogle Scholar