Lateral Arm Flap

Abstract

This first septocutaneous flap was originally introduced in 1982 by Song and coworkers [498] and 2 years later was described in more detail by Katsaros et al. [257]. Similar to the radial forearm flap, the lateral upper arm flap is relatively thin, but limited in width, and can be transferred together with a segment of bone, muscle, or sensory nerves. The flap, which is raised at the lateral aspect of the upper arm, is perfused by the terminal branches of the profunda brachii artery. This artery is not essential for the vascularity of the extremity. Early clinical series document a number of application possibilities, especially in the head and neck area [106, 108, 341, 474, 485, 568]. Because of its texture and the favorable color match, the flap is well suited for replacement of the facial skin [498]. At the extremities, the upper arm flap is useful for defect coverage on the foot, hand, or forearm as a free flap [304, 375, 398, 466, 568] or as a pedicled flap for coverage of defects at the shoulder region [108, 568]. For defect coverage at the temporal region, Inoue and Fujino left the flap pedicled on the cephalic vein, whereas the flap artery was microsurgically anastomosed to a neck artery [243]. Apart from these indications, the lateral upper arm flap can be used for a number of intraoral reconstructions. Matloub and coworkers reported on six reconstructions following partial or total glossectomy or defect coverage at the hard palate [341]. By connecting the posterior cutaneous nerve of the arm to the lingual nerve, they could achieve a neurocutaneous reinnervation. Including a cortical segment of the humerus, a limited amount of bone can be harvested together with the skin paddle, which was used for lower jaw reconstruction [341, 568]. Other authors confirmed the usefulness of the lateral upper arm flap for intraoral reconstructions in larger clinical series [97, 199, 422], especially the high success rate of neurocutaneous reinnervation after nerve coadaptation [97]. When extending the flap to the proximal forearm, the thin and pliable forearm skin can be combined with the thicker flap portion of the upper arm [97]. Moffett and coworkers demonstrated the possibility of dividing the flap, which can then be used for closure of through-and-through defects of the oral cavity [369].