LATERAL ARM MICROVASCULAR FLAP IN HEAD AND NECK RECONSTRUCTION

Objectives: To report our results of a study of 28 patients who underw ent sequential reconstructions of the head and neck using the lateral arm flap. To discuss the situations where we have found the procedure useful, report the complication rates, and delineate the advantages an d disadvantages of using this flap. Design: A clinical series of patie nts was followed up prospectively. The swallowing function of a subgro up that underwent oropharyngeal reconstruction was compared with that of a simultaneous control group that underwent reconstruction with the pectoralis major flap. Setting: University medical center. Participan ts: Patients with malignant neoplasms of the head and neck who underwe nt resections and reconstruction with the lateral arm flap, Interventi ons: Twenty-eight patients underwent head and neck reconstruction usin g lateral arm naps. In 17 patients, the lateral arm flaps were used fo r pharyngeal and posterior oral cavity defects. Thirteen of these pati ents underwent reinnervation, Nine combined palatal and midfacial defe cts were reconstructed, and 1 lateral facial defect was reconstructed. Most cases were advanced malignant neoplasms and represented a select ed minority of similar resections performed at our institutions. Three maxillary reconstructions were performed secondarily. All other recon structions were performed at the time of tumor ablation, Main Outcome Measures: Data were collected regarding flap survival, return of sensa tion in flaps, complication rates. and the ability to feed orally, Res ults: All flaps survived in their entirety. Of 7.5 tested flaps acquir ed sensation, Of 14 patients with large oropharyngeal defects, 8 resum ed early oral feeding and all survivors eventually obtained nutrition orally, The ability to swallow was superior to the results obtained in a retrospective analysis of a group reconstructed using pectoralis Co nclusions: A unique feature of this nap is that it incorporates both t hin skin from the proximal forearm and thicker skin from the upper arm , This is ideal for an oropharyngeal defect, where the thin malleable portion can be used in the posterior oral cavity or pharyngeal wall an d the thicker portion in the tongue base. Either portion can be used a lone as well. The availability of intermediate tissue bulk can also be advantageous for midfacial reconstruction. Sensation can be reliably reconstituted with this flap. We think that the lateral arm nap is ver satile and has particularly low donor-site morbidity.