Free Lateral Arm Flap



Free Lateral Arm Flap


John R. Lien

Kevin C. Chung





ANATOMY



  • The arm is composed of anterior and posterior compartments.



    • Anterior compartment includes the biceps, brachialis, and coracobrachialis muscles.


    • Posterior compartment includes the triceps muscle.


    • The lateral intermuscular septum divides the anterior and posterior compartments laterally.


  • At the midpoint of the humeral shaft, the profunda brachii artery and radial nerve are located within the spiral groove of the humerus.


  • The profunda brachii divides into two main branches within the spiral groove: the radial collateral artery (RCA) and middle collateral artery (MCA).


  • The RCA accompanies the radial nerve and branches into the anterior and posterior radial collateral arteries (ARCA and PRCA) (FIG 1).



    • The PRCA is the nutrient artery for the lateral arm flap, feeding septocutaneous perforators along the lateral intermuscular septum.


    • The PRCA is accompanied by one or two venae comitantes.


  • The posterior antebrachial cutaneous nerve (PACN) branches from the radial nerve and accompanies the PRCA.


PATIENT HISTORY AND PHYSICAL FINDINGS



  • Assess for prior trauma or surgery at the potential donor site.


  • Ensure adequate recipient site debridement.


IMAGING



  • Doppler sonography can be used to ensure intact vascular pedicle and perforators in cases with prior trauma/surgery, but we generally avoid this flap in this situation.


SURGICAL MANAGEMENT



  • Lateral arm flap is indicated for coverage of small to mediumsized defects of the volar and dorsal wrist and hand.


  • Maximum skin island size is 8 × 25 cm, as the flap can be extended distal to the lateral epicondyle along the lateral forearm. Primary donor-site closure is dependent on body habitus, but generally 6 cm width can be closed primarily.


  • Obese patients will have a bulky lateral arm flap that may be cosmetically unappealing in the hand and wrist.


  • The PRCA pedicle is generally limited to 6 cm in length.


  • For extremity reconstruction with bone defect, a vascularized segment of distal humerus may be included in the flap.2


  • Doppler examination is used to center the skin paddle over the vascular pedicle.


  • The patient is placed supine with the hand on a hand table.






FIG 1 • Anatomy of the lateral arm flap.


Oct 14, 2019 | Posted by in Reconstructive surgery | Comments Off on Free Lateral Arm Flap

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