The Lateral Arm Flap

Abstract

The lateral arm flap is a fasciocutaneous flap that can be used either as a pedicled or a free flap. It is a relatively thin flap, although that might not be the case in obese patients or patients with excess skin of the arms, and is mainly used for hand reconstruction as well as head and neck reconstruction. Its major advantage is that it does not sacrifice a major blood supply to the arm. It can be harvested as a fasciocutaneous, fascia-only or osteocutaneous flap, depending on the reconstructive needs of the patient. The flap dimensions can be up to 6×12 cm and the donor site defect can be closed primarily most of the times. The surgical scar produced is often easily concealed. The flap dissection is easy and the anatomy is reliable and constant. It allows the utilization of two teams, minimizing the operative time. When used as a free tissue transfer, the lateral arm flap derives its blood supply from the posterior radial collateral artery. On the other hand, when used as a reverse flow pedicled flap, it derives its blood supply from the recurrent radial collateral artery. The vascular pedicle has a small diameter (1–3 mm) and requires an experienced microsurgeon. The posterior cutaneous nerve needs to be sacrificed during flap dissection, resulting in paresthesias of the lateral arm and that needs to be discussed with the patient prior to proceeding.