Posterior Radial Collateral Artery Perforator Free Flap: Reliable Pedicle Length Independent of Body Height and Arm Length

Background: The posterior radial collateral artery perforator free flap (PRCA flap) is a modification of the lateral arm flap that provides pliable tissue, color match, and primary donor-site closure. However, evidence on pedicle length remains limited, particularly in Asian populations. This study evaluated pedicle length stability and its correlation with body size. Methods: A retrospective review was performed of 100 consecutive PRCA flap reconstructions for head and neck defects at Taipei Medical University Hospital between 2016 and 2024. Demographics, defect sites, flap dimensions, pedicle length, perforator location, recipient vessels, ischemia time, and donor-site closure were analyzed. True pedicle length was defined as the vascular segment from the selected perforator to the proximal transection point, excluding segments with only soft tissue. Correlations with height, arm length, and BMI were tested using regression. Results: The mean age was 55.5 years (range, 27–84), and 85% were male. Malignancies accounted for 80% of defects, most commonly buccal mucosa (40%) and tongue (36%). The mean skin paddle measured 7.4 × 4.3 cm, and mean pedicle length was 9.7 ± 1.4 cm (range, 6–14 cm). The distal perforator was 4.7 ± 1.5 cm proximal to the lateral epicondyle. Pedicle length showed no correlation with height (R² = 0.022), arm length (R² = 0.004), or BMI (R² = 0.013). All donor sites were closed primarily. Conclusions: The PRCA flap provides a reliable pedicle length independent of patient height and habitus, supporting its role as a safe, versatile option for small- to medium-sized head and neck reconstructions, particularly in Asian populations.