Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 11:
The Deltoid Flap
  Unless the flap is small, direct closure of the defect may not be possible and a skin graft may be required. The scarring occurs in an area commonly exposed in both men and women. For this reason and because the tip of the flap is unreliable, the deltoid is used less commonly than other innervated flaps. It has been replaced by the lateral arm and the radial forearm flaps.

PLATE XI-1. Anatomy

A. A line is drawn from the tip of the acromion to the medial condyle at the elbow. This line intersects the bicipital groove, or the groove between the biceps and triceps, and gives one an axis where the neurovascular pedicle comes out. The pedicle usually comes out at the junction of the middle and posterior thirds of this line, but it may be anywhere along the middle third. The vessels come out deep to the deltoid and fan out in an anterior and superior direction to supply the island flap. The terminal cutaneous branch of the axillary nerve, which is purely sensory, joins these vessels as they reach their subcutaneous position. The size of the flap is limited by the anatomic donor area itself. The long axis of the flap is oriented in an oblique inferior-to-superior direction, over the deltoid muscle mass. In a large person, flaps of 15 x 25 to 30 cm can be developed. The posterior extension of the flap should not extend beyond the deltotriceps groove by more than a centimeter or two.


B. Elevation of the flap is begun in an anterior-superior direction, lifting the skin and the underlying fascia, (the latter is densely adherent to the deltoid muscle) by sharp dissection.

C. Once the flap has been elevated toward the posterior border of the muscle, the deltotriceps groove is approached. Several pseudogrooves may be encountered in the deltoid muscle. The muscles on either side of these grooves are parallel, whereas in true deltotriceps groove, the fibers of the lateral head of the triceps muscle course are directed more posteriorly to those of the deltoid as they descend to the olecranon process. The neurovascular pedicle can be identified in the flap by transillumination and can also be checked with a sterile Doppler probe.

D. Once the true deltotriceps groove has been identified, the vascular pedicle can be mobilized deep to the deltoid muscle into the quadrilateral space bounded by the shaft of the humerus anteriorly, the long head of the triceps posteriorly, the teres major inferiorly, and the teres minor superiorly.

next page...

  2002 © This page, and all contents, are Copyright by The Buncke Clinic