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Vol. 16, No. 5, 2007
Issue release date: August 2007
Section title: Original Paper
Open Access Gateway
Med Princ Pract 2007;16:394–398
(DOI:10.1159/000104815)

Application of Lateral Arm Free Flap in Oral and Maxillofacial Reconstruction following Tumor Surgery

Song X. · Yuan Y. · Tao Z. · Wu H. · Yuan H. · Wu Y.
Department of Oral and Maxillofacial Surgery, Stomatological College, Nanjing Medical University, Nanjing, China
email Corresponding Author

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 × 7 to 6 × 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.

© 2007 S. Karger AG, Basel


  

Key Words

  • Lateral arm free flap
  • Oral and maxillofacial area reconstruction
  • Squamous cell carcinoma

References

  1. Ross DA, Thomson JG, Restifo R, Tarro JM, Sasaki CT: The extended lateral arm free flap for head and neck reconstruction: the Yale experience. Laryngoscope 1996;106:14–18.
  2. Richardson D, Fisher SE, Vaughan ED, Brown JS: Radial forearm flap donor-site complications morbidity: a prospective study. Plast Reconstr Surg1997;99:109–115.
  3. Katsaros J, Tan E, Zoltie N, Barton M, Venugopalsrinivasan, Venkataramakrishnan: Further experience with the lateral arm free flap. Plast Reconstr Surg1991;87:902–910.
  4. Shibata M, Hatano Y, Iwabuchi Y, Matsuzaki H: Combined dorsal forearm and lateral arm flap. Plast Reconstr Surg1995;96:1423–1429.
  5. Sobin LH: TNM Classification of Malignant Tumors/UICC, ed 6. New York, Wiley-Liss, 2002.
  6. Song R, Song Y, Yu Y: The upper arm free flap. Clin Plast Surg 1982;9:27–35.
  7. Katsaros J, Schusterman M, Beppu M, Banis JC Jr, Acland RD: The lateral upper arm flap. Anatomy and clinical applications. Ann Plas Surg 1984;12:489–500.
  8. Matloub HS, Sanger JR, Godina M: The lateral arm neurosensory flap. Trans VIII Int Congr Plast Reconstr Surg, Montreal, 1983, p 125.
  9. Kuek LB, Chan TL: The extended lateral arm flap: a new modification. J Reconstr Microsurg 1991;7:167–173.
  10. Gehrking E, Remmert S, Majocco A: Topographic and anatomic study of lateral upper arm transplants. Ann Anat 1998;180:275–280.
  11. Sieg P, Hakim SG, Bierwolf S, Hermes D: Subcutaneous fat layer in different donor regions used for harvesting microvascular soft tissue flaps in slender and adipose patients. Int J Oral Maxillofac Surg 2003;32:544–547.
  12. Yu A, Chen Z, Yu G: Applied anatomy of distal humerus periosteo-cutaneous flap pedicled with collateralis radialis vessels. Chin J Exper Surg 1995;6:368–369.
  13. Reinert S: The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg 2000;28:69–73.
  14. Hamdi M, Landuyt K, Blondeel P: The use of a free and pedicled lateral arm flap for coverage of an extensive degloving injury of the upper extremity. Eur J Plast Surg 2004;27:86–89.

    External Resources

  15. Tan BK, Lim BH: The lateral forearm flap as a modification of the lateral arm flap vascular anatomy and clinical implications. Plast Reconstr Surg 2000;105:2400–2404.
  16. Gellrich NC, Kwon TG, Lauer G, Fakler O, Gutwald R, Otten JE, et al: The lateral upper arm free flap for intraoral reconstruction. Int J Oral Maxillofac Surg 2000;29:104–111.

  

Author Contacts

Dr. Yu-nong Wu
No. 136 Hanzhong Avenue
Nanjing, Jiangsu Province 210029 (China)
Tel. +86 25 8503 1871, Fax +86 25 8651 6414
E-Mail sxm2081@163.com

  

Article Information

Received: May 2, 2006
Revised: October 31, 2006
Number of Print Pages : 5
Number of Figures : 5, Number of Tables : 1, Number of References : 16

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 16, No. 5, Year 2007 (Cover Date: August 2007)

Journal Editor: Owunwanne, A. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Ross DA, Thomson JG, Restifo R, Tarro JM, Sasaki CT: The extended lateral arm free flap for head and neck reconstruction: the Yale experience. Laryngoscope 1996;106:14–18.
  2. Richardson D, Fisher SE, Vaughan ED, Brown JS: Radial forearm flap donor-site complications morbidity: a prospective study. Plast Reconstr Surg1997;99:109–115.
  3. Katsaros J, Tan E, Zoltie N, Barton M, Venugopalsrinivasan, Venkataramakrishnan: Further experience with the lateral arm free flap. Plast Reconstr Surg1991;87:902–910.
  4. Shibata M, Hatano Y, Iwabuchi Y, Matsuzaki H: Combined dorsal forearm and lateral arm flap. Plast Reconstr Surg1995;96:1423–1429.
  5. Sobin LH: TNM Classification of Malignant Tumors/UICC, ed 6. New York, Wiley-Liss, 2002.
  6. Song R, Song Y, Yu Y: The upper arm free flap. Clin Plast Surg 1982;9:27–35.
  7. Katsaros J, Schusterman M, Beppu M, Banis JC Jr, Acland RD: The lateral upper arm flap. Anatomy and clinical applications. Ann Plas Surg 1984;12:489–500.
  8. Matloub HS, Sanger JR, Godina M: The lateral arm neurosensory flap. Trans VIII Int Congr Plast Reconstr Surg, Montreal, 1983, p 125.
  9. Kuek LB, Chan TL: The extended lateral arm flap: a new modification. J Reconstr Microsurg 1991;7:167–173.
  10. Gehrking E, Remmert S, Majocco A: Topographic and anatomic study of lateral upper arm transplants. Ann Anat 1998;180:275–280.
  11. Sieg P, Hakim SG, Bierwolf S, Hermes D: Subcutaneous fat layer in different donor regions used for harvesting microvascular soft tissue flaps in slender and adipose patients. Int J Oral Maxillofac Surg 2003;32:544–547.
  12. Yu A, Chen Z, Yu G: Applied anatomy of distal humerus periosteo-cutaneous flap pedicled with collateralis radialis vessels. Chin J Exper Surg 1995;6:368–369.
  13. Reinert S: The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg 2000;28:69–73.
  14. Hamdi M, Landuyt K, Blondeel P: The use of a free and pedicled lateral arm flap for coverage of an extensive degloving injury of the upper extremity. Eur J Plast Surg 2004;27:86–89.

    External Resources

  15. Tan BK, Lim BH: The lateral forearm flap as a modification of the lateral arm flap vascular anatomy and clinical implications. Plast Reconstr Surg 2000;105:2400–2404.
  16. Gellrich NC, Kwon TG, Lauer G, Fakler O, Gutwald R, Otten JE, et al: The lateral upper arm free flap for intraoral reconstruction. Int J Oral Maxillofac Surg 2000;29:104–111.