Brachioradialis muscle flap: Clinical anatomy and use in soft-tissue reconstruction of the elbow

A detailed gross anatomical dissection of 53 upper extremities was performed to define the muscular and vascular anatomy of the brachioradialis muscle and to evaluate its arc of rotation with specific examination of its usefulness in covering soft-tissue defects of the elbow region. A consistent vascular anatomy was delineated, with a major pedicle found each time near the elbow arising (in descending order of frequency) from the radial recurrent, radial, and brachial arteries. A variable number of minor pedicles were found throughout the muscle's length. Pedicled proximally, the distal muscle could cover the elbow both anteriorly and posteriorly in each case; the proximal portion of the muscle (distally pedicled flap) could cover the anterior elbow consistently (100%) as well as the posterior elbow (in 91% of dissections). The muscle's arc of rotation encompasses the distal half of the arm and the proximal two thirds of the forearm, with a consistent ability to cover defects of up to 3 cm in the elbow region. Our studies confirm a consistent and robust vascular anatomy as well as an arc of rotation that allows predictable coverage of elbow defects in a one-stage procedure with minimal morbidity, no loss of upper extremity function, and no need to sacrifice the major vessels of the upper extremity.