Application of Lateral Arm Free Flap in Oral and Maxillofacial Reconstruction following Tumor Surgery

Abstract

Objective: To describe the application of lateral arm free flap (LAFF) in reconstruction of defects in the oral and maxillofacial regions following ablative oncological surgery. Subjects and Methods: The study included 16 patients (13 male, 3 female, mean age 56, range 35–69 years). Sixteen LAFF were harvested to reconstruct defects caused by the dissection of malignant tumors of the oral and maxillofacial regions. The tumor was squamous cell carcinoma of the tongue (6 cases), floor of the mouth (4), retromolar area (3), inner cheek (2), and lower gingival (1). Flap sizes ranging from 5 × 7 to 6 × 9 cm were harvested using a sterile tourniquet for bloodless technique. The anastomoses were carried out using a magnifier or microscope. All donor defects were closed primarily. Results: Fourteen flaps healed without venous insufficiency. One flap, in a female patient, survived with mild local microcirculatory obstruction but that of another female patient developed necrosis. There was no significant complication at the donor sites. The advantages of this flap include anatomically reliable vascular supply, accessible donor site, and the aesthetic quality of donor tissue is good. Compared with the radial artery, the posterior radial collateral artery is a nonessential vessel of the arm. The disadvantages are the relatively smaller vessel size for anastomosis and thicker subcutaneous tissue. Conclusions: For the repair of moderate-sized defects of the maxillofacial area, especially in male patients, the LAFF can be recommended.

Free profunda femoris artery perforator flap as a first-line choice of reconstruction for partial glossectomy defects

“…Debate about differences in functional outcomes of these 2 flaps is extensive, with most authors concluding that both have similar results and tending to favor the latter because of suggested better resistance to postradiotherapy deformity, donor site potential complications, and aesthetic concerns . Many other free flap options have been described for reconstruction of the partial glossectomy defect, including the lateral arm, gracilis, vertical rectus abdominis myocutaneous, tensor fasciae latae, peroneal artery, medial sural perforator, anteromedial, anterior tibial perforator, superficial circumflex iliac artery, deep inferior epigastric artery perforator, and supraclavicular and rectus abdominis musculoperitoneal flaps. Most of those flaps have shown good outcomes at the expense of a difficult dissection, donor site morbidity, inconvenience of flap harvest, or the need of more extensive (and expensive) preoperative evaluation, therefore, they are reserved as the second choice for comorbid patients or those in which traditional ALT or radial forearm could not be used for other reasons.…”

Radial Forearm Free Flap for Reconstruction of a Large Defect after Radical Ablation of Carcinoma of the Tongue and Floor of the Mouth: Some New Modifications

“…However, as the muscle is involved, morbidity in the donor site cannot be ignored. We [22] have also used the lateral arm free flap to reconstruct some small to medial intraoral defects in places such as the retromolar area, the floor of the mouth, the tongue and the inner cheek. However, the pedicle is not long enough to provide a distal portion of de-epithelialized soft tissue.…”

Use of modified lateral upper arm free flap for reconstruction of soft tissue defect after resection of oral cancer

“…However, tissue defects that are created by resection of oral cancer can severely affect speech and swallowing as well as disturb the aesthetic appearance of the oral cavity. A variety of free tissue flaps have been researched and then widely used in the reconstruction of tumor-related defects in the oral cavity [ 5 ], with the most common flaps included the anterolateral tight flap and the pectoralis major and latissimus dorsi muocutaneous flap. Unfortunately, these flaps are bulky and not always suitable for restoring the function of the delicate oral anatomy [ 5 ].…”

“…A variety of free tissue flaps have been researched and then widely used in the reconstruction of tumor-related defects in the oral cavity [ 5 ], with the most common flaps included the anterolateral tight flap and the pectoralis major and latissimus dorsi muocutaneous flap. Unfortunately, these flaps are bulky and not always suitable for restoring the function of the delicate oral anatomy [ 5 ]. In 1982, Song et al [ 6 ] introduced the lateral upper arm free flap (LAFF), which has since been used in a variety of anatomical reconstruction procedures for areas including the head and neck because it is a thin, soft, and sensory tissue flap that offers a suitable amount of tissue and color for reconstruction as well as low morbidity at the donor site [ 5 – 8 ].…”

“…Unfortunately, these flaps are bulky and not always suitable for restoring the function of the delicate oral anatomy [ 5 ]. In 1982, Song et al [ 6 ] introduced the lateral upper arm free flap (LAFF), which has since been used in a variety of anatomical reconstruction procedures for areas including the head and neck because it is a thin, soft, and sensory tissue flap that offers a suitable amount of tissue and color for reconstruction as well as low morbidity at the donor site [ 5 – 8 ]. However, the utility of the LAFF in the repair of oral defects following resection of oral cancer has not been established in the literature.…”