Lateral Arm Flap: Usage as Pedicle and Free Flap :A Case Series

1. Introduction One aspect of reconstructive surgery is to replace any lost tissue with similar tissue. With advent of microsurgery it is now possible to achieve better aesthetic results with reduced donor site morbidity.

For soft tissue replacement, Radial Forearm Flap had been the procedure of choice since its description in Chinese literature. Problems associated with Radial forearm flap included donor site morbidity and loss of major artery of forearm. This was replaced by anterolateral thigh flap that was described by Song et al in 1984 1 and popularized by Fu Chan Wei. 2 However, its drawback comprises of it being a bulky flap.

Lateral arm free flap was first described by Katsaros et al 3 is a versatile free flap, which can be used in many reconstructions and is now commonly used in upper extremity reconstruction both as a reverse pedicle and as a free flap. It is well suited to cover defects where a thin flap is required especially dorsum of the hand.3, 4, 5 Having advantage of being thinner than the anterolateral thigh flap it also does not sacrifice a major artery and has acceptable donor site morbidity. However, its drawback includes a shorter pedicle and smaller skin paddle. 6

Here investigator share his experience of using the lateral arm flap both as a free flap and as a pedicle flap. 2. Materials and Methods A retrospective review of 21 patients who underwent lateral arm flap reconstruction for various defects in the body from January 2012 to December 2016 was carried out. Patients were grouped into two main categories and were followed for 3 weeks post operatively .Group 1 included patients who had Free Lateral Arm Flap (FLAF), Group 2 included those who had reconstruction using Pedicle Lateral Arm Flap (PLAF). Data was collected using a standard Performa containing details about patient's age, sex, etiology of defect, area involved, size of flap and outcome (survival/failure) of the flap. For free flaps, this also included the recipient vessels used for anastomosis and the number of veins anastomosed. The work has been reported in line with the PROCESS criteria.7

4. Operative Procedure: Operative procedure was the same as described in literature. 7 The vascular supply of the lateral arm flap is the posterior radial collateral artery (PRCA) which is the branch of the radial collateral artery. The PRCA runs in the lateral intermuscular septum of the arm. A line drawn from the deltoid insertion to the lateral epicondyle denotes the lateral intermuscular septum. (Fig 1 a) Anteriorly, the intermuscular septum is bounded by brachialis and brachioradialis and posteriorly by the triceps. If ELAF extended lateral arm flap is required then a line is drawn from the lateral epicondyle to the radial styloid.