The radial nerve, the superior profunda or the posterior radial collateral vessels, and the posterior cutaneous nerve of the arm and forearm wind around the humerus in the spinal groove.

B. The relationships between the skin flap lateral intermuscular septum and neurovascular structures are shown.

PLATE VIII-2

A. The posterior border of the flap has been incised, as well as the fascia overlying the triceps muscle and tendon.

B. The fascia, tacked to the skin island, is elevated anteriorly to and down on the posterior surface of the lateral intramuscular septum, preserving septal vessels and nerves, to the bony origin of the septum.

C. The anterior edge of the flap has been incised and the fascia over the biceps, brachialis, and brachioradialis elevated in a similar fashion to and including the anterior surface of the intermuscular septum. The large posterior cutaneous nerve of the arm and forearm traverses the flap and must be taken with the flap even though it does not innervate it.

PLATE VIII-3

A. The skin island, tacked to the fascia, is completely mobilized on the septum. The distal septum has been cut down to its humeral origin and is being detached proximally, visualizing the radial nerve as it emerges from the spinal groove from the lateral to the anterior muscular compartment.

B. The dissection has proceeded proximally to the level of the deltoid insertion and spinal groove. Additional proximal exposure can be gained by incising the lateral head of the triceps from its origin. Cutaneous branches of the lateral nerve enter the septum with the vascular perforators to innervate the skin island.

Clinical Cases

CASE 1

A 42-year-old man had a vascular malformation of the medial ankle that had been treated by excision and closure by split-thickness skin grafts on several occasions.

FIG. 8-01. The patient now has an unstable scar that is prone to recurrent breakdown.

next page...