The use of the lateral arm flap in upper limb surgery

Katsaros, James; Tan, Eugene; Zoltie, N.; Venkataramakrishnan,

doi:10.1016/0363-5023(91)90180-j

Cited by 37 publications

(22 citation statements)

References 6 publications

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“…Numerous techniques to reconstruct upper limb defects have previously been described which includes locoregional flaps, 9,10 distant flaps 1,11 and free tissue transfer. 1,9,[12][13][14][15] Each reconstructive option depends on the institution and is individualised to the patient and type of defect. 16 Size of the defect, arc of rotation and amount of available surrounding tissue, which can be compromised in a severely traumatised limb are the serious limitations in considering locoregional flaps as reconstructive options.…”

Section: Resultsmentioning

confidence: 99%

Abdominal Flaps in the Management of Upper Limb Defect- Our Experience

Rachwani-Anil¹,

Prabhu²,

Kumar³

2017

jemds

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BACKGROUNDSoft tissue defects in upper limb are commonly seen as a sequel to trauma and burns, leading to exposure of important structures such as vessels, nerves, tendons and bone. These structures require primary cover at the earliest. Although, in the present era of microvascular reconstruction locoregional pedicled flaps are fading, abdominal flaps prove to be handy in reconstruction of upper limb soft tissue defects.The aim of this retrospective descriptive study is to prove the versatility and simplicity of abdominal flap in reconstruction of upper limb defects.

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Section: Resultsmentioning

confidence: 99%

Abdominal Flaps in the Management of Upper Limb Defect- Our Experience

Rachwani-Anil¹,

Prabhu²,

Kumar³

2017

jemds

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“…Protective sensation may be restored using neurovascular, fasciocutaneous free flaps, e.g., the lateral arm flap as demonstrated by Song et al 23 and further established by Katsaros et al, 24 and the radial forearm flap initially described by Song et al 25 The latter may be used as a free or local, pedicled flap when there is no additional trauma to the forearm. Sensate free lateral arm flaps have shown improved sensory recovery compared with conventional fasciocutaneous or musculocutaneous flaps in the upper extremity.…”

Section: Unit (R) And/or Unit (U) Defects Of the Palmmentioning

confidence: 95%

Functional resurfacing of the palm: Flap selection based on defect analysis

et al. 2011

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Extensive defect coverage of the palm and anatomical reconstruction of its unique functional capacity remains difficult. In manual laborers, reconstruction of sensation, range of motion, grip strength but also mechanical stability is required. Sensate musculo-/fasciocutaneous flaps bear disadvantages of tissue mobility with shifting/bulkiness under stress. Thin muscle and fascial flaps show adherence but preclude sensory nerve coaptation. The purpose of this review is to present our algorithm for reliable selection of the most appropriate procedure based on defect analysis. Defect analysis focusing on units of tactile gnosis provides information to weigh needs for sensation or soft tissue stability. We distinguish radial unit (r)-thenar, ulnar unit (u)-hypothenar and unit (c)-central plus distal palm. Individual parameters need similar consideration to choose adequate treatment. Unit (r) and unit (u) are regions of secondary touch demanding protective sensation. Restoration of sensation using neurovascular, fasciocutaneous flaps is recommended. In unit (c), tactile gnosis is of less, mechanical resistance of greater value. Reconstruction of soft tissue resistance is suggested first in this unit. In laborers, free fascial- or muscle flaps with plantar instep skin grafts may achieve near to anatomical reconstruction with minimal sensation. Combined defects involving unit (c) require correlation with individual parameters for optimal flap selection. Defect coverage of the palm should not consist of merely providing sensate vascularized tissue. The most appropriate procedure should be derived from careful defect analysis to achieve near to anatomical reconstruction. In laborers, defect related demands need close correlation with sensation and mechanical stability to be expected.

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“…They found that the humerus derives a periosteal blood supply from the small branches of the posterior branch of the radial collateral artery (PBRCA), without describing any further anatomical details. Later, the same authors (Katsaros et al, 1991a) presented three more cases. The first was a traumatic bone defect of the first metacarpal in which primary reconstruction was achieved by use of a 2 cm bone strut with a small lateral arm flap.…”

Section: Introductionmentioning

confidence: 92%

Lateral arm flap: Analysis of its anatomy and modification using a vascularized fragment of the distal humerus

et al. 2003

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Soft tissue injuries with associated bone defects are difficult to manage and often require prolonged treatment with repeated interventions. Frequently, a free flap is applied as a first step and bone grafting is carried out in a second procedure. Ideally, these two procedures are combined in one operation, utilizing a soft tissue flap with an attached vascularized bone fragment. The lateral arm flap can provide such an osteoseptocutaneous flap and has been utilized clinically with success; however, the vascular anatomy of the flap, especially the humeral fragment, has not been described in detail previously, and there is broad disagreement concerning its innervation. In this study, the arteries and nerves of 24 fresh cadaver arms were dissected after injection of colored latex. The levels of origin of the periosteal arteries of the humerus were also documented. The lateral arm flap has a consistent arterial supply from three septocutaneous perforating branches that are arranged in a predictable pattern. The lateral supracondylar ridge of the humerus is vascularized by direct branches of the posterior branch of the radial collateral artery and by arteries that arise from muscular branches supplying adjacent muscles. The innervation of the lateral arm flap is by the inferior lateral cutaneous nerve of the arm. Knowledge of the consistent vascular anatomy of the lateral humerus and soft tissue of the donor site allows an osteoseptocutaneous flap to be raised safely with an appropriate technique. We recommend use of the lateral arm flap with a humeral fragment for the treatment of combined soft tissue and bone defects when a single step surgical solution is indicated.

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The use of the lateral arm flap in upper limb surgery

Cited by 37 publications

References 6 publications

Abdominal Flaps in the Management of Upper Limb Defect- Our Experience

Abdominal Flaps in the Management of Upper Limb Defect- Our Experience

Functional resurfacing of the palm: Flap selection based on defect analysis

Lateral arm flap: Analysis of its anatomy and modification using a vascularized fragment of the distal humerus

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