The Pedicled Lateral Arm Flap for Oncologic Reconstruction Near the Shoulder

Abstract

Oncologic resections near the shoulder create challenging reconstructive problems. In addition to severe contour defects and the risk for functional deficits resulting from contractures, there may be exposed bone and peripheral nerves rendering simple skin graft closures suboptimal long term. The lateral arm flap is a versatile septofasciocutaneous flap based on the posterior branch of the radial collateral artery in the lateral intermuscular septum of the upper arm. This paper details our experience with 3 patients who underwent wide local excision or radical resection of soft tissue tumors of the upper arm and closure with pedicled lateral arm fasciocutaneous flaps. Flap size ranged from 6 × 10 cm to 5 × 15 cm. Two flaps were transferred as 180-degree pivotal flaps; 1 flap was transferred as an advancement flap. There were no immediate postoperative complications or long-term functional deficits. The pedicled lateral arm flap is a safe and reliable option for soft tissue coverage of anterolateral shoulder defects. The vascular pedicle lies deep within the mid-upper arm and is rarely at risk during extensive tumor extirpation. The adjacent donor site allows for a single operative field without the need for repositioning and furthermore results in a skin paddle requirement that is one half the width of the original defect.

Color Doppler Sonographic and Cadaveric Study of the Arterial Vascularity of the Lateral Upper Arm Flap

“…The technique of closing the donor site depends on the width of the flap. Direct closure is usually limited to a maximum width of 6 cm 2 , 5 , 7 . The width of the flap can be up to 14 cm, but in this situation, a split skin graft is needed to close the defect 2 , 5 – 7 .…”

“…Direct closure is usually limited to a maximum width of 6 cm 2 , 5 , 7 . The width of the flap can be up to 14 cm, but in this situation, a split skin graft is needed to close the defect 2 , 5 – 7 . Although the maximum length of the vascular pedicle was 7 to 8 cm, as measured from the insertion of the deltoid muscle, 2 a pedicle length of 12 to 14 cm can be achieved by following the radial nerve proximally and detaching the tendon of the lateral head of the triceps muscle, so that a limited pedicle length does not mean a restriction in the use the lateral upper arm flap 6 , 7 .…”

“…The lateral upper arm flap has been increasingly used for small to medium-sized defects because of its pliable nature, ease of harvest, available vascular supply, and minimal donor site morbidity. 2,[5][6][7][8] The flap is potentially sensate, and there is a unique vascular plexus, allowing great variability in design and thus making the lateral upper arm flap one of the most adaptable flaps, not only in head and neck reconstruction but also in hand and upper and lower extremity reconstruction. [7][8][9] The flap can be designed to be up to 15 cm in length.…”

“…2,5,7 The width of the flap can be up to 14 cm, but in this situation, a split skin graft is needed to close the defect. 2,[5][6][7] Although the maximum length of the vascular pedicle was 7 to 8 cm, as measured from the insertion of the deltoid muscle, 2 a pedicle length of 12 to 14 cm can be achieved by following the radial nerve proximally and detaching the tendon of the lateral head of the triceps muscle, so that a limited pedicle length does not mean a restriction in the use the lateral upper arm flap. 6,7 In this study, 3.02 ± 0.88 large perforators (diameter >0.5 mm) were identified by color Doppler sonography in each upper arm, and most of the perforators were located in the upper region (range, 1.0-6.5 cm) of the external epicondyleof the humerus.…”

Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

“… 12 It may be difficult to identify true surgical-site infections with ADM so patients given oral or intravenous antibiotics alone (Clavien type II) were not included. 13 …”