Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 11:
The Deltoid Flap
  The deltoid flap was designed and developed by John D. Franklin, who noted the neurovascular pedicle while widely excising a melanoma in this area. In a 2-year period from 1980 to 1982, 35 of these new flaps were transplanted by Franklin and his co-workers. 1,2 In recent years, with the evolvement of the lateral arm and radial forearm flaps, this flap has become less popular. It is a sensate cutaneous flap comparable to the dorsalis pedis flap in the quality of sensation recovered following reinnervation. The flap is relatively thin in the normal patient. It is thinnest in the upper shoulder area, and invariably has greater subcutaneous tissue in women. A long vascular pedicle of 6 to 8 cm can be obtained by following the vessels to the posterior circumflex humeral artery. Here, the artery is 1.5 mm in diameter and the venae comitantes 2.0 mm in diameter.

The deltoid flap can be considered whenever relatively thin innervated cover is needed in the hand and the weight-bearing areas of the foot. Its color match with facial skin makes it a good choice in head and neck reconstruction. Unfortunately, the donor defect is in an exposed area of the body that traditionally heals with hypertrophic scarring, particularly in young individuals. The variability of the site of entrance of the neurovascular pedicle occasionally makes the elevation of this flap a challenge.


As first described by Franklin et al.,1 the cutaneous branch from the posterior humeral circumflex vessel usually runs in the septum between the deltoid and triceps muscles, 2 cm posterosuperior to the junction of this groove with a line drawn from the tip of the acromion to the medial epicondyle. We have found in our cadaver dissections that the pedicle tends to be farther posterosuperior along the deltotriceps groove than in the original description; in one instance, it was 4 cm away from the anticipated location.

Multiple muscular branches from the posterior circumflex humeral vessel arise just proximal to the cutaneous branch of the vessel. For the pedicle to be lengthened, these branches must be meticulously dissected, ligated, and divided, tracing the pedicle proximally through the quadrilateral space.

The cutaneous branch of the axillary nerve innervates the deltoid flap. During the dissection of this nerve or the adjacent vascular pedicle, injury to the axillary nerve must be avoided.

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