The use of the distal posterior radial collateral artery as recipient vessel in elbow resurfacing using SCIP flap

Abstract

Dear Editor, Elbow soft-tissue reconstruction represents a challenge for microsurgeons because simple reconstructive solutions such as primary closure and skin grafting may be usually suboptimal, especially when facing large defects where free flaps should be considered (Adkinson & Chung, 2014; Chen et al., 2004; Choudry et al., 2007; Hamdi et al., 2004; Ooi et al., 2016). The most used option for recipient vessels in free flap transfer is major vessels (i.e. brachial and radial) and their recurrent branches. In case vessels will cross the elbow joint, limb mobilization may be reduced to avoid the risk of vessel kinking, which may delay a full recovery of range of motion (ROM) in the early period. In elective cases, recipient vessel preoperative selection may improve safety and performance and nowadays, ultrasound technology including ultra-high frequency ultrasound (UHF-US) allows very detailed preoperative planning of both flap and recipient vessels especially in the hands of the operating microsurgeon (Visconti et al., 2020). Here, we show the use of posterior collateral radial artery (PRCA) as a first choice recipients for a case of free flap elbow resurfacing in a 57-year-old female patient affected by an openwound of 3 3 cmwith no bone exposure and a sorrounding area of 10 10 cm of chronic radiodermitis with contour deformity, related to radiation therapy for the treatment of haemangioma done at the age of 1 year old (Figure 1a). The patient developed a progressive reduced ROM, with elbow obliged in a resting position of 30 in flexion and ROMof 0 in extension and 30 in flexion. The patient complained severe functional limitation in all daily activities including self-care, cosmetic unsatisfaction, and physicological distresswith an overall reduced quality-of-life. Preoperatively, the recipient site was studied using UHF-US where the PRCA, its perforators and the cephalic veinwere identified andmarked. PRCA is the pedicle of the lateral arm flap and its use as recipient vessel has been never described before, likely because of small-sized vessels, mismatching with the pedicle of conventional perforator flaps. However, for perforator flaps with limited pedicle dissection and for flaps with pedicle of small caliber (i.e., superficial circumflex iliac artery perforator, SCIP), PRCA may represent a valid solution to consider. In fact, as in the case example reported, PRCA showed a good