Verifying the Versatility and Reliability of Free Lateral Arm Flap for Head and Neck Reconstruction

Abstract

The lateral arm flap is an alternative to the conventional radial forearm flap and has been widely used due to advancements in flap characteristics. Especially, the fasciocutaneous flap has been widely used in head and neck reconstruction due to its versatile characteristics and surgical feasibility. This flap has successfully undergone several useful modifications based on various anatomical studies. Here, the authors aimed to verify the versatility and reliability of free lateral arm flap reconstruction of numerous head and neck defects. Twelve patients (6 men and 6 women; mean age, 66 years) with various types of lateral arm flaps from May 2017 to April 2019 were included. The anatomical reconstruction area was widely distributed across the facial subunits, tongue and oral cavity, and hypopharynx, among others. The flap varied in size from 3 × 5 cm to 17 × 7 cm, and the average pedicle length was 5.58 cm. The versatility of the lateral arm flap enabled successful coverage of various defects in all cases. Among 12 patients, the donor site outcome was rated as excellent and good by 2 and 10 patients, respectively. Three patients complained of post-operative hypoesthesia, which was subsequently resolved. The lateral arm flap is a unique and extremely versatile soft tissue free flap. Its versatility facilitates continuous modification of the flap and its application in various areas in different forms with excellent contour outcomes. The authors successfully verified the evolving methods and advantages of lateral arm flaps in the treatment of various head and neck defects.

Survival of Dental Implants Placed in Iliac, Fibula, and Radial Forearm Flaps: A Comprehensive Review

“…While the radial forearm free flap provides a sensate, pliable, and thin skin paddle with a long vascular pedicle and easy technical harvest, it can lead to severe donor site morbidity, particularly from flexor tendon exposure resulting from unsuccessful skin graft harvesting, as well as altered sensation in the radial nerve, aesthetic deformity, reduced range of motion, and grip strength [ 22 ]. The lateral arm flap offers a distinctive and highly versatile soft tissue flap, allowing continuous alterations with exceptional contour results in different sites and forms [ 26 ]. By utilizing a modified suprafascial technique, the risk of flexor tendon exposure can be reduced by preserving the deep area of the fascia overlaying the tendons, resulting in an improved graft recipient bed [ 22 ].…”

“…It is worth noting that the radial artery carries the primary vascular supply to the hand, and previous research has shown that the radial artery is smaller than the ulnar artery in the proximal forearm but has a larger diameter at the wrist [ 22 ]. The lateral arm flap has been introduced in the literature as an alternative to the traditional radial forearm flap, primarily due to improvements in the characteristics of the flap [ 26 ]. A demonstration of the radial forearm free flap and flap size is shown in Figure 3 .…”

Radial Forearm Free Flap for Head and Neck Defect Reconstruction: An Up-to-date Review of the Literature

“…The lateral arm flap is considered a distinctive and highly versatile soft tissue flap. The versatility of the flap provides a continuous alteration of the flap, in addition to its uses in different sites and forms with outstanding contour results [9]. A modified suprafascial technique can provide less risk of exposure of the flexor tendon by aiming to preserve the deep area of the fascia that overlays the tendons, therefore improving the graft recipient bed [6].…”

Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head and Neck Reconstruction

“…Published single institutional series are limited to 2 to 48 patients. 3,[12][13][14] Here, we report the largest single-institution series of patients who underwent traditional lateral arm, extended lateral arm, or lateral forearm free flaps for head and neck reconstruction. This study aims to characterize outcomes, donor-site morbidity, and complications of lateral arm flaps.…”

“…Despite the lower morbidity of the lateral arm flap, its use in head and neck reconstruction has not been widely adopted. Published single institutional series are limited to 2 to 48 patients 3,12‐14 …”