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Contrera KJ, Hassan AM, Shuck JW, Bobian M, Ha AY, Chang EI, Garvey PB, Roubaud MS, Lee ZH, Hanasono MM, Gross ND, Myers JN, Yu P, Largo RD. Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head and Neck Reconstruction. Otolaryngol Head Neck Surg 2024; 170:747-757. [PMID: 38037485 DOI: 10.1002/ohn.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/10/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Examine outcomes for lateral arm autologous tissue transfer in head and neck reconstruction. STUDY DESIGN Retrospective cohort study. SETTING Tertiary cancer center. METHODS All patients who underwent traditional lateral arm, extended lateral arm, and lateral forearm flaps for head and neck reconstruction from 2012 to 2022 were assessed. Disabilities of the arm, shoulder, and hand (DASH) was measured. Factors associated with complications and enteral or mixed diet were evaluated by multivariable regression. RESULTS Among 160 patients followed for a median of 2.3 ± 2.1 years, defects were 54% oral tongue, 18% external, 9% maxilla, 8% buccal mucosa, 9% floor of mouth, and 3% pharynx. Flap types (and median pedicle lengths) were 41% traditional lateral arm (8 cm), 25% extended lateral arm (11.5 cm), and 34% lateral forearm (14 cm). All donor sites were closed primarily; 19.6% and 0% of patients had increased DASH scores 2 and 12 weeks after reconstruction. Major complications occurred in 18.1% of patients, including 6.3% reoperation, 6.9% readmission, 3.7% fistula, and 1.8% flap loss. Complications were independently associated with peripheral vascular disease (odds ratio [OR]: 5.71, 95% confidence interval [CI]: 1.5-21.6, P = .01), pharyngeal defects (OR: 11.3, 95% CI: 1.4-94.5, P = .025), and interposition vein grafts (OR: 3.78, 95% CI: 1.1-13.3, P = .037). CONCLUSION The lateral arm free flap was safe, versatile, and reliable for head and neck reconstruction with low donor-site morbidity. Complications occurred in a fifth of patients and were associated with peripheral vascular disease, pharyngeal defects, and vein grafts.
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Affiliation(s)
- Kevin J Contrera
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abbas M Hassan
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John W Shuck
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Bobian
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Austin Y Ha
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Edward I Chang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margaret S Roubaud
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Z-Hye Lee
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mathew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Danker S, Shuck JW, Taher A, Mujtaba B, Chang EI, Chu CK, Liu J, Garvey PB, Hanna E, Yu P, Largo RD. The lateral forearm flap versus traditional upper extremity flaps: A comparison of donor site morbidity and flap thickness. Head Neck 2023; 45:2413-2423. [PMID: 37464915 DOI: 10.1002/hed.27446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The lateral forearm flap (LFF) is a thin fasciocutaneous flap with a donor site that can be closed primarily. METHODS A retrospective analysis of donor site morbidity and hand function was performed in patients who underwent a radial forearm flap (RFF), ulnar artery perforator flap (UAPF), or LFF. Flap thickness was evaluated radiographically in 50 control patients. RESULTS Of 134 patients (lateral forearm flap: n = 49, RFF: n = 47, UAPF: n = 38), the LFF demonstrated significantly faster return to baseline hand grip strength (3 months vs. 12 months in RFF and UAPF; p < 0.001), had significantly fewer donor site complications (6.1% compared to 6.4% in RFF and 28.9% in UAPF; p = 0.003) and fewer sensory deficits (2.0% compared to 6.4% in RFF and 15.8% in UAPF sites; p = 0.013). The radiographic study confirmed the LFF to be the thinnest of all upper extremity flap options. CONCLUSIONS The LFF is an excellent forearm-based flap option with thin, pliable tissue and low donor site morbidity.
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Affiliation(s)
- Sara Danker
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - John W Shuck
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Taher
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Bilal Mujtaba
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Edward I Chang
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Carrie K Chu
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Patrick B Garvey
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Hanna
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Verifying the Versatility and Reliability of Free Lateral Arm Flap for Head and Neck Reconstruction. J Craniofac Surg 2020; 31:e688-e693. [PMID: 32804818 DOI: 10.1097/scs.0000000000006586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The lateral arm flap is an alternative to the conventional radial forearm flap and has been widely used due to advancements in flap characteristics. Especially, the fasciocutaneous flap has been widely used in head and neck reconstruction due to its versatile characteristics and surgical feasibility. This flap has successfully undergone several useful modifications based on various anatomical studies. Here, the authors aimed to verify the versatility and reliability of free lateral arm flap reconstruction of numerous head and neck defects. Twelve patients (6 men and 6 women; mean age, 66 years) with various types of lateral arm flaps from May 2017 to April 2019 were included. The anatomical reconstruction area was widely distributed across the facial subunits, tongue and oral cavity, and hypopharynx, among others. The flap varied in size from 3 × 5 cm to 17 × 7 cm, and the average pedicle length was 5.58 cm. The versatility of the lateral arm flap enabled successful coverage of various defects in all cases. Among 12 patients, the donor site outcome was rated as excellent and good by 2 and 10 patients, respectively. Three patients complained of post-operative hypoesthesia, which was subsequently resolved. The lateral arm flap is a unique and extremely versatile soft tissue free flap. Its versatility facilitates continuous modification of the flap and its application in various areas in different forms with excellent contour outcomes. The authors successfully verified the evolving methods and advantages of lateral arm flaps in the treatment of various head and neck defects.
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Abstract
PURPOSE OF REVIEW The aim of this study was to review the recent literature on the utilization of the lateral arm free flap use in head and neck reconstruction. RECENT FINDINGS The lateral arm free flap provides a reliable fasciocutaneous free tissue transfer option ideally suited for reconstruction of the oral cavity, pharynx and parotid. Primary donor site closure, compartmentalized fat and excellent colour match make it an excellent option for head and neck reconstruction. Donor site morbidity is low, and the primary limitation is the short and narrow vascular pedicle. SUMMARY The lateral arm free flap should be considered in cases of oral cavity and skin reconstruction, particularly in cases wherein pedicle length is not restrictive.
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Kang SY, Eskander A, Patel K, Teknos TN, Old MO. The unique and valuable soft tissue free flap in head and neck reconstruction: Lateral arm. Oral Oncol 2018; 82:100-107. [DOI: 10.1016/j.oraloncology.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/07/2018] [Accepted: 05/12/2018] [Indexed: 11/25/2022]
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Han HH, Choi EJ, Oh DY, Moon SH. The usefulness of microsurgical pedicle lengthening in free anterolateral thigh flaps. Microsurgery 2016; 36:559-566. [DOI: 10.1002/micr.30042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Eun Jeong Choi
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Suk Ho Moon
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
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Yang XD, Zhao SF, Zhang Q, Wang YX, Li W, Hong XW, Hu QG. Use of modified lateral upper arm free flap for reconstruction of soft tissue defect after resection of oral cancer. Head Face Med 2016; 12:9. [PMID: 26825783 PMCID: PMC4731961 DOI: 10.1186/s13005-016-0105-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the suitability of a modified lateral upper arm free flap (LAFF) for reconstruction of soft tissue defects after resection of oral cancer. METHODS Eighteen cases of soft tissue defect repair performed between January 2011 and December 2013 using a modified LAFF after resection of oral cancer were reviewed. The design and harvest of the LAFF, the reconstruction procedure, and postoperative morbidity were reviewed and evaluated over a follow-up period of at least 12 months. RESULTS The overall flap survival was 94.4 % (17/18 patients). A broad scar at the donor site was the most common morbidity, but patients did not report dissatisfaction with the scar because they could easily cover it. All wounds at the donor site achieved primary recovery. One case of flap loss was repaired with a radial forearm free flap. One case complicated by diabetes mellitus involved infection of the flap with one-third of the flap becoming necrotic. This flap survived after removal of the necrotic tissue. In one other case, fat liquefactive necrosis (1.5 × 1.0 cm) occurred in the flap on the tip of the tongue, and this flap survived after debridement. Overall, the shape and function of the reconstructed tissues were well restored, and there was no severe morbidity at the donor site in any case. CONCLUSION The modified LAFF was safe and reliable for the reconstruction of soft tissue defects after resection of oral cancer.
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Affiliation(s)
- Xu-Dong Yang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Su-Feng Zhao
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Qian Zhang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Yu-Xin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Wei Li
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Xiao-Wei Hong
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Qin-Gang Hu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
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Steel BJ, Cope MR. A Brief History of Vascularized Free Flaps in the Oral and Maxillofacial Region. J Oral Maxillofac Surg 2015; 73:786.e1-11. [DOI: 10.1016/j.joms.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 11/29/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
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Busnardo FF, Coltro PS, Olivan MV, Faes JC, Lavor E, Ferreira MC, Rodrigues AJ, Gemperli R. Anatomical comparison among the anterolateral thigh, the parascapular, and the lateral arm flaps. Microsurgery 2014; 35:387-92. [DOI: 10.1002/micr.22357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/05/2014] [Accepted: 11/10/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Fábio F. Busnardo
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Pedro S. Coltro
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Marcelo V. Olivan
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Jose C. Faes
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Elizeu Lavor
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Marcus C. Ferreira
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Aldo J. Rodrigues
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
| | - Rolf Gemperli
- Division of Plastic Surgery and the Cancer Institute of São Paulo; University of São Paulo School of Medicine; São Paulo Brazil
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Marques Faria JC, Rodrigues ML, Scopel GP, Kowalski LP, Ferreira MC. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg 2008; 61:172-9. [DOI: 10.1016/j.bjps.2007.10.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 04/03/2007] [Accepted: 10/16/2007] [Indexed: 11/29/2022]
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Song XM, Yuan Y, Tao ZJ, Wu HM, Yuan H, Wu YN. Application of lateral arm free flap in oral and maxillofacial reconstruction following tumor surgery. Med Princ Pract 2007; 16:394-8. [PMID: 17709930 DOI: 10.1159/000104815] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 10/02/2006] [Indexed: 11/19/2022] Open
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 x 7 to 6 x 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.
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Affiliation(s)
- Xiao-meng Song
- Department of Oral and Maxillofacial Surgery, Stomatological College, Nanjing Medical University, Nanjing, China
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Spyriounis PK. The Extended Approach to the Vascular Pedicle of the Anterolateral Thigh Perforator Flap: Anatomical and Clinical Study. Plast Reconstr Surg 2006; 117:997-1001; discussion 1002-3. [PMID: 16525298 DOI: 10.1097/01.prs.0000200616.63843.a7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The anterolateral thigh perforator flap is a well-described and versatile flap that has specific advantages. However, the variable anatomy makes flap elevation challenging. Furthermore, the dissection of the proximal part of the pedicle that runs underneath the rectus femoris muscle demands continuous pull by an assistant and is inconvenient and tiring for the surgeon. A technique that facilitates dissection of the proximal pedicle part is suggested. It is useful in both pedicled and free flap transfer, when maximum pedicle length is crucial. METHODS Five anterolateral thigh perforator flaps were dissected using the extended technique. Four were transferred as free flaps and one as an island pedicled flap. In addition, anatomical cadaver studies were performed bilaterally in five fresh cadavers to further clarify the relevant anatomy. RESULTS All flaps survived well. One patient suffered from donor-site infection caused by inadequate drainage. Conservative treatment with daily dressing changes resulted in satisfactory healing. Two patients suffered from hypesthesia of part of the lateral thigh area. No patient experienced any difficulty in daily activities and none suffered from knee extension lag. CONCLUSIONS An extended approach for dissection of the anterolateral thigh perforator flap is described that is useful in both pedicled and free flap transfers. Cautious tunnel creation is a prerequisite for avoidance of complications.
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Abstract
The forearm part of the extended lateral arm flap may be separately raised on the most distal septocutaneous perforator of the posterior collateral radial artery. This truly distal lateral arm flap shares most of the advantages of the radial forearm flap and is associated with less donor site morbidity. From April 2000 to March 2004, we used 30 such flaps as the fasciocutaneous free flap of choice, mostly for reconstructions in the head and neck region. The eventful postoperative course observed in 5 of these flaps motivated us to evaluate the rationale and risk factors of this procedure. We prospectively analyzed the influence on the incidence of partial or complete flap loss of 19 patient-related or procedure-related characteristics that may have acted as risk factors. None were found to be of statistical significance. We found the distal lateral arm flap to have a less robust vascular anatomy than the radial forearm flap, resulting in the need for advanced surgical expertise to raise and handle it. As we recognized the difficulty of this flap to be associated predominantly with this anatomy of its vascular pedicle, we now take a more liberal stand toward the possibility of intraoperative conversion to the use of a radial forearm flap.
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Affiliation(s)
- J Joris Hage
- Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Schipper J, Ridder GJ, Boedeker CC, Fradis M, Golz A, Gellrich NC. Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery. Report of six consecutive cases. Ann Otol Rhinol Laryngol 2003; 112:611-6. [PMID: 12903681 DOI: 10.1177/000348940311200707] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.
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Affiliation(s)
- Jörg Schipper
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany
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Abstract
Soft-tissue defects of the head and neck are often reconstructed with fasciocutaneous free flaps. The radial forearm flap is used most commonly, however the lateral arm flap may be the flap of choice in certain situations. Advantages include flap elevation with simultaneous tumor ablation, avoidance of intraoperative patient position changes, and primary closure of the donor site. After extirpative procedures of the head and neck region, 4 patients were reconstructed with the lateral arm flap. Flap survival was 100%, a vein graft to supplement the short pedicle length was necessary in 1 patient, all donor sites were closed primarily, and secondary procedures to reduce flap bulk were necessary in 2 patients. The lateral arm flap is an excellent alternative to the radial forearm flap and should be included in the armamentarium of the reconstructive head and neck surgeon.
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Affiliation(s)
- M Y Nahabedian
- Division of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Alcalde J, Pastor MJ, Quesada JL, Martín E, García-Tapia R. [Reconstruction of oropharyngeal defects with lateral arm flap]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2001; 52:39-44. [PMID: 11269878 DOI: 10.1016/s0001-6519(01)78175-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The lateral arm flap, is a fasciocutaneous flap with great versatility, but underused in head and neck reconstruction. Its qualities include a intermediate thickness between the radial forearm flap and the pectoralis major, ideal to reconstruct oropharyngeal defect, a consistent vascular pedicle, a pliable soft tissue and a low donor site morbidity. Use of this flap does not require the sacrificing of a major feeding vessel to the arm. We have chosen this technique to reconstruct four cases with surgical defects in oral cavity and oropharynx. The anatomic and functional results have been satisfactory and the complications rate is comparable to other microvascular techniques. We think that the lateral arm free flap is a useful reconstructive technique in specific areas of head and neck.
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Affiliation(s)
- J Alcalde
- Departamento de ORL, Clínica Universitaria de Navarra, Avda. Pío XII s/n: Pamplona 31008
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Hamdi M, Coessens BC. Evaluation of the donor site morbidity after lateral arm flap with skin paddle extending over the elbow joint. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:215-9. [PMID: 10738327 DOI: 10.1054/bjps.2000.3325] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The free lateral arm flap may be extended to include the skin over the lateral aspect of the elbow and the forearm. However, extending the flap beyond the lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the lateral aspect of the elbow joint. Seventeen consecutive lateral arm flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the forearm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by flap harvesting (P = 0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contralateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm(2)(range 20-75 cm(2)) was found on the posterolateral surface of the forearm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the lateral arm flap over the lateral condyle.
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Affiliation(s)
- M Hamdi
- Department of Plastic Surgery, Brugmann University Hospital, Brussels, Belgium
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Gellrich NC, Kwon T, Lauer G, Fakler O, Gutwald R, Otten JE, Schmelzeisen R. The lateral upper arm free flap for intraoral reconstruction. Int J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0901-5027(00)80006-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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