The Free Lateral Arm Flap—A Reliable Option for Reconstruction of the Forearm and Hand

Abstract

Background

This retrospective study was performed to verify the advantages and disadvantages of the free lateral arm flap for defect reconstruction of the forearm and hand.

Patients and Methods

Between 2001 and 2010, 21 patients underwent defect coverage of the forearm and hand with the free lateral arm flap. The mean patient age was 48 years (17–78). The results concerning defect origin, flap size, pedicle length, operative time, revisions of the anastomoses or other complications, donor site morbidity, and length of hospital stay were evaluated.

Results

The majority of defects were caused by infections or chronic wounds. The defects were localized at the forearm in 6 cases and at the hand in 15 cases. The flap width ranged from 3 to 8 cm, and the length was from 5 to 20 cm. All flaps survived. Only in one case, a revision of the anastomosis was necessary. Primary closure of the donor site was possible in all patients. No complications occurred during the healing procedure. The majority of the patients were satisfied with the aesthetic result at the recipient site as well as at the donor site.

Conclusion

The free lateral arm flap is a very reliable option for defect coverage at the forearm and hand for small and medium size defects. A satisfactory aesthetic appearance, an excellent tissue quality, and frequent primary donor site closure are great advantages for selecting this flap.

Keywords

Free lateral arm flap Reconstruction of the forearm and hand Defect coverage Donor site morbidity

Get full access to this article

View all access options for this article.

References

Atzei

Pignatti

Udali

. et al. The distal lateral arm flap for resurfacing of extensive defects of the digits. Microsurg. 2007;27:8–16.

Biswas

Lohani

Chari

. The sandwich temporoparietal free fascial flap for tendon gliding. Plast Reconstr Surg. 2001;108:1639–45.

Chen

El-Gammal

. The lateral arm fascial free flap for resurfacing of the hand and fingers. Plast Reconstr Surg. 1997;99:454–9.

Chowdary

Murphy

. Delayed debulking of free muscle flaps. Br J Plast Surg. 1992;45:38–41.

Flügel

Heitmann

Kehrer

. et al. Coverage of soft-tissue defects of the hand with free fascial flaps. Microsurg. 2005;25:47–53.

Flügel

Kehrer

Heitmann

. et al. Defect coverage of the hand with the free serratus fascial flap. Handchir Mikrochir Plast Chir. 2005;37:186–92.

Gedebou

Wei

Lin

. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir. 2002;34:239–44.

Gohla

Kehrer

Holle

. et al. Functional and aesthetic refinements of free flap coverage at the dorsum of the hand and distal forearm. Unfallchirurg. 2007;110:5–13.

Graham

Adkins

Scheker

. Complications and morbidity of the donor and recipient sites in 123 lateral arm flaps. J Hand Surg (Br). 1992;17:189–92.

10.

Haas

Rappl

Koch

. et al. Free osteocutaneous lateral arm flap: anatomy and clinical applications. Microsurgery. 1992;23:87–95.

11.

Hallock

. The utility of both muscle and fascia flaps in severe upper extremity trauma. J Trauma. 2002;53:61–5.

12.

Harpf

Papp

Ninkovic

. et al. The lateral arm flap: review of 72 cases and technical refinements. J Reconstr Microsurg. 1998;14:39–48.

13.

Hennerbichler

Etzer

Gruber

. et al. Lateral arm flap: analysis of its anatomy and modification using a vascularized fragment of the distal humerus. Clin Anat. 2003;16:204–14.

14.

Hoefert

Hoffmann

Zerfowski

. et al. Funktionelle und ästhetische Entnahmemorbidität lateraler Oberarmlappen. Symposium der Arbeitsgemeinschaft für Kieferchirurgie 2005. www.ag-kiefer.de/symposium_Mai_2005/abstracts.htm.

15.

Hou

Lou

. Vascularized tendon graft using lateral arm flap. 5 microsurgery cases. Acta Orthop Scand. 1993;64:373–6.

16.

Ito

Igawa

Suzuki

. et al. Evaluation of the donor site in patients who underwent reconstruction with a free radial forearm flap. J Reconstr Microsurg. 2005;21:113–7.

17.

Karamursel

Bagdaty

Markal

. et al. Versatility of the lateral arm free flap in various anatomic defect reconstructions. J Reconstr Microsurg. 2005;21:107–12.

18.

Katsaros

Schustermann

Beppu

. et al. The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg. 1984;12:489–500.

19.

Kremer

Bickert

Germann

. et al. Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps. Plast Reconstr Surg. 2006;118:443–54.

20.

Kreutzer

Sauerbier

. Plastic reconstruction on the lower limb. Z Orthop Unfall Up2date. 2010;5:97–124.

21.

Moser

Gohritz

Van Schoonhoven

. et al. The free lateral arm flap in reconstructive hand surgery. Eur J Plast Surg. 2004;27:81–5.

22.

Sauerbier

Erdmann

Bickert

. et al. Defect coverage of the hand and forearm with a free scapula–parascapula flap. Handchir Mikrochir Plast Chir. 2001;33:20–5.

23.

Sauerbier

Giessler

. The lateral arm flap for defect closure at the hand and wrist. Master techniques in orthopedic surgery series—soft tissue. 1st ed. In: Cooney

Moran

, editors. Lippincott Williams & Wilkins; 2009. p. 179–89.

24.

Sauerbier

Ofer

Germann

. et al. Microvascular reconstruction in burn and electrical burn injuries of the severely traumatized upper extremity. Plast Reconstr Surg. 2007;119:605–15.

25.

Song

. et al. The upper arm free flap. Clin Plast Surg. 1982;9:27–35.

26.

Sullivan

Carrol

Kuriloff

. Lateral arm free flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 1992;118:1095–101.

27.

Summers

Matloub

Sanger

. Salvage of ischemic digits using a lateral arm fascial flap. Plast Reconstr Surg. 2001;107:398–407.

28.

Ulusal

Lin

Ulusal

. et al. Free lateral arm flap for 1-stage reconstruction of soft tissue and composite defects of the hand: a retrospective analysis of 118 cases. Ann Plast Surg. 2007;58:173–8.

29.

Waterhouse

Healy

. The versatility of the lateral arm flap. Br J Plast Surg. 1990;43:398–402.

30.

Wechselberger

Schoeller

Pülzl

. et al. Free tissue transplantation for defect coverage of the dorsum of the hand: aesthetic and functional aspects. Handchir Mikrochir Plast Chir. 2003;35:245–50.

31.

Yildirim

Taylan

Eker

. et al. Free flap choice for soft tissue reconstruction of the severely damaged upper extremity. J Reconstr Microsurg. 2006;22:599–609.

32.

Yousif

Warren

Matloub

. et al. The lateral arm fascial free flap: its anatomy and use in reconstruction. Plast Reconstr Surg. 1990;86:1138–45.