The extended lateral arm flap in head and neck reconstruction

Abstract

Background. The lateral arm flap has been proven to be a reliable and versatile flap for the coverage of small to moderated-sized defects, especially in the head and neck and in the extremities. This flap has been modified by either extending the vascular pedicle or the flap territory. Methods. From September 1997 to October 2000, we performed 17 free lateral arm flaps with extension of the flap size, including 1 osteofasciocutaneous flap for the coverage of head and neck defects. The reconstructions included a partial circumference defect of the esophagus, extensive intraoral defects, through-and-through bucco-cheek defect, etc. Follow-up was from three months to 12 months, with an average of 8 months. Results. All but one flaps survived completely. Necrosis of the distal part occurred in one flap. Follow-up of donor sites revealed minimal morbidity when the flaps were extended to the below-elbow level. Conclusions. The cutaneous territory of the lateral arm flap, based on the posterior radial collateral artery, can be extended distally onto the forearm up to 10 cm. The center point of the flap design could be located more distally toward the lateral epicondyle in order to increase the size of the flap and the length of the vascular pedicle. The lateral arm flap provides a considerable amount of thin, pliable fasciocutaneous tissue. The advantages of the flap are constant anatomy, very easy and fast dissection, and the donor site being easier to camouflage than that of the radial forearm flap. The lateral arm flap is an excellent choice of fasciocutaneous flap for the reconstruction of head and neck defects.