Efficacy of Reverse – Flow Lateral Arm Flap for Coverage of defects Around the Elbow in Pediatric Patients

Abstract

Background: Coverage of defects around the elbow can be treated by a variety of procedures as skin grafts, regional flaps, muscle flaps and free flaps. The reverse flow lateral arm flap (LAF) is a valuable option in coverage of these defects. The vascular basis of this flap, viz, the multiple communications around the elbow between the collateral and recurrent arteries, is consistent and reliable.Aim of the study: To explore the utility of the distally based lateral arm flap (LAF) in management of defects around the cubital fossa region.Patients and methods: This work was executed at The Menoufia University Hospitals, from October 2017 to December 2018, following our cases postoperatively for average one year. It entailed eight patients, six boys and two girls. The age of our cases was from 4 to 11 years. Six patients had post-burn contracture release defects, and 2 patients had traumatic avulsion of antecubital skin. All the defects were covered by the reverse- flow lateral arm flap (LAF) with skin grafting of the donor site.Results:All the flaps survived completely, except one case showed distal superficial necrosis and healed spontaneously. We applied skin graft to the flap donor site in the eight patients. Flap size ranged from 15x7 cm. to 12x5cm. Aesthetically, the flap and donor sites were satisfactory, and functionally, the range of motion of elbow was very adequate. One patient developed transient radial nerve palsy and completely recovered by conservative treatment and physiotherapy.Conclusion: The reverse flow lateral arm flap (LAF) is a valuable single-stage option in coverage of defects around the elbow. It provides reliable and stable coverage of these defects without sacrificing major vessel or functional muscle unit. The flap had satisfactory aesthetic and functional outcome.