Lateral Arm Free Flaps in the Defects of the Upper Extremity — A Review of 72 Cases

Abstract

Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. Five patients were operated on as emergencies, 12 were operated within the first 72 hours of injury and 57 patients were treated electively. Skin defects were between 6 x 4 cm and 20 x 9 cm. Five (7%) flaps were lost due to venous thrombosis, three that sustained a high-voltage electric burn. Two other patients that were treated for a high-voltage electric burn had a successful revision of the anastomosis site in the early post-operative duration. One flap was abandoned due to very thin pedicle and obesity of the patient. A higher failure rate is encountered most frequently with the cases of high-voltage electric burn. To deal with this problem, a modified approach such as an extended approach and/or including the forearm skin to the flap is recommended during the flap harvest. For a longer pedicle to be anatomized more proximally, perforator flaps with longer pedicles may be used as an alternative.

Early Fasciotomy in Electrically Injured Patients as a Marker for Injury Severity and Deep Venous Thrombosis Risk: An Analysis of the National Burn Repository

“…In a series of patients who required free flap upper extremity reconstruction, flap success rate was notably different between electrically injured versus non-electrically injured patients (81% versus 97%). The authors conclude that “in high voltage electric injuries, higher [vein thrombosis] rates should be expected because of possible recipient vessel injuries” 23.…”

Free Tissue Transfer for Upper Extremity Reconstruction

“…17,18 While the vascular pedicle is dependable, the lateral arm flap is limited somewhat by the short length of its relatively small pedicle. 2,19 The scapular and parascapular free flaps blood supply is from branches of the subscapular arterial system. These flaps are arranged transversely and obliquely in relationship to the midline of the back.…”

Soft-Tissue Coverage for Elbow Trauma

“…31 The lateral arm can be used as a free, pedicled, or contralateral cross arm flap. 13,32-34 Composite flaps with sensation, muscle, or bone have been described. 35 The length can be extended up to 15cm past the lateral epicondyle.…”