AN ANATOMIC AND TOPOGRAPHIC STUDY OF THE LATERAL UPPER ARM FREE-FLAP FOR THE CLINICAL USE IN RECONSTRUCTION

Defects of the laryngopharynx and the oral cavity after cancer ablatio n are increasingly reconstructed by free microvascular anastomosed tis sue transfer. Besides the jejunum transplant, we use the free radial f orearm flap frequently. This flap is suitable for restoring intraoral and pharyngeal integrity. Major disadvantages are the requirement of a skin graft to obtain wound closure and the cosmetic deformity. The la teral upper arm free flap is intended as alternative method for the fa sciocutaneous tissue transfer. Based on our dissection of ten cadavers we demonstrate the anatomy of the flap, the harvesting technique, and present data of vascular pedicle length, vessel calibers, and flap si ze. The vessel calibers of the profund brachial artery ((x) over bar = 2.5 mm) and its terminal branch, the posterior radial collateral arte ry ((x) over bar = 1.8 mm), are comparable to the radial artery. The p edicle length can be extended up to 13 cm by using a lateral approach. The subcutaneous tissue Volume was 1.3 cm in average, and compared to the radial flap rather thick. Because of its bulky and strong fascia, the lateral arm flap seems to be useful as a fascia-fat flap in facia l augmentation and as a fascia flap in soft tissue reconstruction. Dis advantageous are the difficult dissection technique and the loss of se nsitivity on the lateral aspect of the forearm. Where a fasciocutaneou s flap is indicated, we prefer the radial forearm flap.