Free osteocutaneous lateral arm flap: Anatomy and clinical applications

Abstract

For many surgeons, the potential to reconstruct skin, fascia, tendon, or bone in a single-stage procedure has made the lateral arm flap the technique of choice for reconstruction of complex defects. The aim of this study was to examine more closely how the humeral bone is supplied by the posterior collateral radial artery. To this end, we dissected 30 cadaver arms to determine the vascular relationship of the lateral arm flap to the humerus. The number of directly supplying vessels, and height to the lateral epicondyle of the humerus, were examined. The reconstructive potential of the osteocutaneous flap in different indications is analyzed in a series of five clinical cases. In all dissected extremities, we found one or two branches of the posterior collateral artery directly and constantly supplying the bone between 2-7 cm proximal to the lateral epicondyle. In five cases, combined defects, including bone, were successfully reconstructed with lateral arm flaps, including vascularized bone.

Reconstructive potential of the lateral arm flap after tumor resection

“…4,[6][7][8] There is a constant number of fascial and fasciocutaneous perforators, 12 muscular perforators to the triceps muscle, 6 branches to the triceps tendon, 6 and branches directly supplying the bone. 13 Short pedicle length has been criticized in previous reports, but additional pedicle length may be obtained proximally by detaching the lateral head of the triceps muscle to pursue the deep brachial artery in the spiral groove. Distally the flap can be easily extended over the lateral epicondyle.…”

“…For small skeletal defects, a flap including a segment of vascularized humerus is well suited and well proven. 11,13,22 For complex defects affecting skin and mucosa, we use lateral arm sandwich-flaps, whereby a fasciocutaneous lateral arm flap with a deepithelialized component between the two skin islands, corresponding to the skin and mucosal defect, is harvested. In a one-stage procedure, this defect can be repaired with a good functional and esthetic outcome.…”

Pedicled Extended Late ral Arm Fasciocutaneous Flap: Our Experience in BIRDEM

“…Though there are many reports of usefulness of reverse lateral arm flap for elbow coverage. Flap has been used to cover elbow defects due to high voltage electrical injury 4 , olecranon bursitis 5 , avulsion injury 5 , post burn antecubital contractures 12 and posterior elbow defects 17 we did not find any literature regarding its use as a cross-arm flap, while the groin flap and abdominal-chest flaps are a popular choice for hand defects, they require positioning of the hands in anatomically difficult positions and result in bulky flaps that require defatting.…”

“…Numerous variations of the flap were described, as a fascial flap 2,3,4 or partly using a combination of different tissue components as the osteofasciocutaneous flap (with distal humerus corticalis 5,6,7 ), sensate flap (posterior brachial cutaneous nerve 8,6,9 ), musculotendofasciocutaneous flap 5 using triceps muscle components 10 but we did not find any reference of a cross arm flap in our literature search. The lateral arm flap can also be extended distal to the lateral epicondyle of the elbow 8 .…”

Modified Innervated Radial Collateral Artery Perforator Flap for Repairing Digital Defects

“…In 1998, Harpf et al [21] described a series of 72 lateral arm flaps, 70 of which were used as fasciocutaneous flaps. The anatomy of radial collateral arteries makes them suitable as free flap donor areas [22,23]. Arnez et al [24] published a study on three patients who underwent thumb reconstruction by using osteocutaneous neurosensory lateral arm free flaps.…”