Advertisement

Lateral Arm Flap

  • Klaus-Dietrich Wolff
  • Frank Hölzle

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].

Supplementary material

Video 4.1

Lateral arm flap (MPG 122146 kb)

References

  1. 98.
    Civantos FJ Jr, Burkey B, Lu FL, Armstrong W (1997) Lateral arm microvascular flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 123(8):830–836CrossRefGoogle Scholar
  2. 107.
    Cormack GC, Lamberty BG (1984) Fasciocutaneous vessels in the upper arm: application to the design of new fasciocutaneous flaps. Plast Reconstr Surg 74(2):244–250CrossRefGoogle Scholar
  3. 109.
    Culbertson JH, Mutimer K (1987) The reverse lateral upper arm flap for elbow coverage. Ann Plast Surg 18(1):62–68CrossRefGoogle Scholar
  4. 164.
    Gehrking E, Remmert S, Majocco A (1998) Topographic and anatomic study of lateral upper arm transplants. Ann Anat 180(3):275–280CrossRefGoogle Scholar
  5. 200.
    Harii K, Ebihara S, Ono I, Saito H, Terui S, Takato T (1985) Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plast Reconstr Surg 75(4):463–476CrossRefGoogle Scholar
  6. 248.
    Inoue T, Fujino T (1986) An upper arm flap, pedicled on the cephalic vein with arterial anastomosis, for head and neck reconstruction. Br J Plast Surg 39(4):451–453CrossRefGoogle Scholar
  7. 262.
    Katsaros J, Schusterman M, Beppu M, Banis JC Jr, Acland RD (1984) The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg 12(6):489–500CrossRefGoogle Scholar
  8. 307.
    Kuek LB, Chuan TL (1991) The extended lateral arm flap: a new modification. J Reconstr Microsurg 7(3):167–173CrossRefGoogle Scholar
  9. 310.
    Lamberty BG, Cormack GC (1990) Fasciocutaneous flaps. Clin Plast Surg 17(4):713–726PubMedGoogle Scholar
  10. 349.
    Matloub HS, Larson DL, Kuhn JC, Yousif NJ, Sanger JR (1989) Lateral arm free flap in oral cavity reconstruction: a functional evaluation. Head Neck 11(3):205–211CrossRefGoogle Scholar
  11. 378.
    Moffett TR, Madison SA, Derr JW Jr, Acland RD (1992) An extended approach for the vascular pedicle of the lateral arm free flap. Plast Reconstr Surg 89(2):259–267CrossRefGoogle Scholar
  12. 406.
    O’Brien B, Morrison WA (1987) Reconstructive microsurgery. Churchill, LivingstonGoogle Scholar
  13. 411.
    Park MC (1986) An anatomic study of the radial collateral branch of deep brachial artery. Plast Reconstr Surg 78(2):273–274Google Scholar
  14. 431.
    Reinert S (2000) The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg 28(2):69–73. doi:S1010-5182(00)90118-5 [pii] 10.1054/jcms.2000.0118
  15. 440.
    Rivet D, Buffet M, Martin D, Waterhouse N, Kleiman L, Delonca D, Baudet J (1987) The lateral arm flap: an anatomic study. J Reconstr Microsurg 3(2):121–132CrossRefGoogle Scholar
  16. 475.
    Scheker LR, Kleinert HE, Hanel DP (1987) Lateral arm composite tissue transfer to ipsilateral hand defects. J Hand Surg [Am] 12(5 Pt 1):665–672CrossRefGoogle Scholar
  17. 483.
    Schustermann MA, Acland RD, Banis JC, Beppu M 1983 The lateral arm flap: an experimental and clinical study. In: Williams HC (ed) Transactions of the VIII international congress of plastic surgery, MontrealGoogle Scholar
  18. 494.
    Shenaq SM (1987) Pretransfer expansion of a sensate lateral arm free flap. Ann Plast Surg 19(6):558–562CrossRefGoogle Scholar
  19. 507.
    Song R, Song Y, Yu Y (1982) The upper arm free flap. Clin Plast Surg 9(1):27–35PubMedGoogle Scholar
  20. 519.
    Sun R, Ding Y, Sun C, Li X, Wang J, Li L, Yang J, Ren Y, Zhong Z (2016) Color Doppler sonographic and cadaveric study of the arterial vascularity of the lateral upper arm flap. J Ultrasound Med 35(4):767–774. doi:10.7863/ultra.15.01032CrossRefPubMedGoogle Scholar
  21. 577.
    Waterhouse N, Healy C (1990) The versatility of the lateral arm flap. Br J Plast Surg 43(4):398–402CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Klaus-Dietrich Wolff
    • 1
  • Frank Hölzle
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryKlinikum rechts der Isar, Technische Universität MunichMunichGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital of RWTH Aachen UniversityAachenGermany

Personalised recommendations