Lateral-arm free flap for reconstruction in the head and neck

Objective: To describe the role of the lateral-arm free flap in reconstruction of head and neck defects following ablative oncologic surgery and to discuss the anatomy of this flap as well as indications for its use. Design: A prospective study of all patients undergoing a lateral-arm free flap was performed. Up to 3 years of follow-up was obtained. Setting: Tertiary referral centre. Method: A total of 12 lateral-arm free flaps were utilized to reconstruct defects ranging in size from 4 x 7 to 10 x 7 cm. Maximum width of the flap was 7 cm. A mean area of 55 cm ² was harvested. Main outcome measures: Flap survival, morbidity, speech intelligibility, and oral function and intake were assessed. Results: The vascular pedicle was reliable with vessel diameters of 1.5 mm, and length of 6 to 7 cm. All flaps survived, and minimal donor site morbidity was encountered. Nine patients maintained good speech with adequate intelligibility while 10 patients maintained adequate oral intake. Conclusions: Functional results can be obtained with the lateral-arm free flap. A consistent pedicle of good length and size was found. It is our flap of choice in older, thinner individuals when the width of the donor site is less than 7 cm, which allows for primary closure.