THE DISTALLY BASED LATERAL ARM FLAP FOR INTRAORAL SOFT-TISSUE RECONSTRUCTION

Background: The radial forearm flap is probably the most frequently us ed among free flaps for intraoral soft tissue reconstruction. However, this flap is not always available. The other fasciocutaneous flaps ma y be too bulky or less pliable or may have a short vascular pedicle; t heir use is therefore less than ideal. We present a variant of the lat eral arm flap located distally to the lateral epicondyle and having th e same advantages as the radial forearm flap. Methods: Vascular study (dissection and radiography) was previously undertaken to determine th e vascular anastomotic network in the epicondylar area, between the po sterior radial collateral artery and recurrent arteries running in fro nt of the lateral epicondyle. This demonstrated the possibility of tak ing a skin paddle on and below the lateral epicondyle, based on the pr oximal pedicle. Results: We used this flap on three patients for intra oral soft tissue reconstruction (tonsil, floor of the mouth, and pirif orm sinus). No complication with the flap itself was encountered. In a ll cases, direct closure of the donor site was possible, with no local complication. Conclusion: The distal lateral arm flap (LAF) represent s an interesting and reliable alternative to the fasciocutaneous radia l forearm flap. The positioning of the skin paddle over the lateral ep icondyle and the proximal third of the lateral aspect of the forearm i ncreases pedicle length, thus avoiding the use of vein grafts. Dissect ion is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures eas ier placement and more pliability when compared with the standard LAF. (C) 1997 John Wiley & Sons, Inc.