The free lateral arm flap in reconstructive hand surgery

Microsurgical tissue transplantation has provided a great advance in reconstructive surgery, especially regarding upper limb defects. Compared to conventional pedicled flaps, mobilisation can occur earlier, hospital stay is shorter and no additional interventions for pedicle detachment and flap inset are needed. The lateral arm flap is an exceptionally versatile free flap with straightforward dissection and low donor site morbidity. End-to-side anastomosis preserves blood flow through the main arteries to the hand and reduces the risk of vascular compromise of the hand, which is especially important in case of severe hand injuries. Sixteen patients who underwent hand reconstruction using the lateral arm free flap are reviewed. All arterial anastomoses were conducted in end-to-side-technique either to the radial or the ulnar artery. There was no total- or partial-flap failure and only one revisional procedure due to a haematoma under the anastomosis. Eight flaps required secondary defatting, combined with removal of osteosynthesis material or tenolysis. From our point of view the free lateral arm flap is a very reliable and versatile method to resurface small and medium sized hand defects.     

The lateral arm free flap in lower extremity reconstruction

Reconstruction of skin defects of the distal third of the leg and foot is often a difficult task. Shape, resistance to shearing stresses in the weight-bearing surface and sensibility are the main features that have to be restored. For coverage of this region, the authors have used, in selected patients, the lateral arm flap (LAF) since 1994. This flap is thin, easy to dissect and has the possibility to be innervated through the posterior cutaneous nerve of the arm. Fourteen cases are presented. The drawbacks of this flap are the loss of sensibility in the forearm (partially transient) and the scar on the arm, which can be rather unsightly in young ladies and when big flaps are harvested skin graft is needed.     

臂外侧穿支皮瓣修复手指皮肤缺损的临床应用

目的 探讨臂外侧穿支皮瓣治疗手指皮肤缺损的临床效果. 方法 收集新鲜尸体10具(20侧),使用动脉显影技术进行灌注.CT扫描,数据导入Mimics图形工作站,对臂外侧穿支血管三维重建,并模拟皮瓣设计,所有标本CT扫描后统一进行尸体解剖;从2007年4月-2011年7月,对18例手指皮肤缺损的患者,缺损面积3 cm ×4 cm～6 cm ×9cm,采用游离臂外侧皮瓣修复皮肤缺损,术后随访其疗效. 结果 尸体解剖结果显示,肱深动脉穿支管径为(0.71±0.15)mm,肌穿支(Mc)蒂长与肌间隙穿支(Sc)蒂长之比为(2.74 ±0.42) cm:(2.96 ±0.37) cm;桡侧副动脉后支的穿支管径为(0.94±0.22) mm,肌穿支(Mc)蒂长与肌间隙穿支(Sc)蒂长之比为(4.78±0.63)cm:(4.86 ±0.51)cm.三维重建的结果显示,上臂外侧穿支血管主要来源于肱深动脉和桡侧副动脉后支的穿支.皮瓣一期全部成活,供区伤口直接缝合或植皮,一期愈合,所有18例病例均得到随访,随访时间6个月～3年,平均11个月,皮瓣外观稍臃肿,质地和感觉恢复较好. 结论 臂外侧穿支皮瓣营养血管解剖恒定,皮瓣质地和感觉恢复好,是修复手指外伤后中、小面积皮肤缺损的一种有效可行的方法.     

Achilles tendon cover using a free lateral arm fascial flap

Cover of an exposed Achilles tendon is a rare but difficult surgical problem. Two cases are presented in which a free lateral arm fascial flap covered with a split-thickness skin graft was used. The morbidity of the donor site was very low, and the functional result was good. Surgical techniques and results are presented. Received: 30 April 1997 / Accepted: 29 January 1998     

侧胸游离皮瓣修复面颈部软组织缺损

临床应用侧胸皮瓣进行带蒂、岛状、吻合血管的游离移植已多年。这一皮瓣具有多血管供血、质地薄软、无毛发生长、供区大而隐蔽及易于直接缝合等突出优点。我们为16名面颈部软组织缺损病例采用吻合血管的侧胸游离皮瓣修复,13例全部成活,3例失败。并对手术适应证和禁忌证、皮瓣的切取方式及范围进行了讨论。术中采用了血液稀释和血管吻合轮技术。     

The use of a free and pedicled lateral arm flap for coverage of an extensive degloving injury of the upper extremity

Classical skin free flaps are rarely used to cover large skin defects of the upper extremity because of the limited donor size. Muscle flaps with a skin graft are preferred because they provide a large amount of cover and a good blood supply. A case report is presented in which a double skin flap was used to cover a large defect (40×8 cm) extending from the lateral humeral condyle to the dorsal aspect of the hand. A free lateral arm flap from the contra–lateral arm was successfully used in conjunction with a pedicled reversed lateral arm flap from the injured limb. We suggest that skin flaps should be considered for cover of skin defects. The lateral arm flap, which is a versatile flap, offers thin, pliable and sensate skin with minimal donor site morbidity.     

Chest wall reconstruction using pedicled extended serratus anterior myocutaneous flap combined with vascularized rib

An extended serratus anterior myocutaneous flap with a vascularized rib has been used, in two cases, for reconstruction of large full-thickness chest wall defects after resection of recurrent breast cancer. Using this method, the bony support and the soft tissue of the chest wall can be safely reconstructed.     

侧胸游离皮瓣修复面颈部软组织缺损

临床应用侧胸皮瓣进行带蒂、岛状、吻合血管的游离移植已多年。这一皮瓣具有多血管供血、质地薄软、无毛发生长、供区大而隐蔽及易于直接缝合等突出优点。我们为１６名面颈部软组织缺损病例采用吻合血管的侧胸游离皮瓣修复，１３例全部成活，３例失败。并对手术适应证和禁忌证、皮瓣的切取方式及范围进行了讨论。术中采用了血液稀释和血管吻合轮技术。     

跗外侧动脉岛状皮瓣修复足部软组织缺损

目的介绍跗外侧动脉岛状皮瓣修复足部软组织缺损的方法。方法根据跗外侧动脉的解剖设计包含足外侧皮神经分支的岛状皮瓣,覆盖前足及踝部软组织缺损。结果皮瓣及植皮全部成活,术后随访10月～4年,患足外形及功能满意。结论跗外侧动脉岛状皮瓣为修复足部软组织缺损提供了一种方法。     

游离小腿外侧腓动脉穿支皮瓣修复手前臂及足部皮肤缺损

目的介绍游离小腿外侧腓动脉穿支皮瓣修复手前臂及足部皮肤缺损的临床效果。方法以腓动脉应用解剖为基础,术前超声多普勒定位血管蒂,并以此为中心设计皮瓣。皮瓣面积：5cm×9cm-10cm×20cm。2009年10月-2012年5月,应用游离小腿外侧腓动脉穿支皮瓣修复手前臂及足部皮肤缺损17例。结果17例皮瓣及供区植皮全部成活,受区外形及功能满意,小腿功能无影响。结论游离小腿外侧腓动脉穿支皮瓣是修复手前臂及足部皮肤缺损的理想方法。     

Reversed lateral upper arm flap with a vascularised fragment of the humerus for reconstruction of ulna shaft fracture after resection of malignant tumour: A case report

The lateral upper arm flap (LAF) is used for a pedicled flap with the vascular arcade at the elbow. There has been no report, however, with regard to the reverse lateral upper arm flap (R-LAF) with a vascularised humerus as an osteocutaneous flap. We describe the case of a 72-year-old woman with a fracture of the ulna after wide resection of a malignant tumour at the proximal half of the forearm, which was reconstructed with an R-LAF with a vascularised fragment of the distal humerus. The flap has successfully survived and the fracture was healed without any adverse event. The R-LAF with vascularised bone is a useful option for the simultaneous treatment of soft tissue and bone defects.     

足跗外侧动脉岛状皮瓣修复足前部皮肤缺损

目的 探讨足跗外侧动脉岛状皮瓣修复足前部皮肤缺损的临床疗效.方法 2007年3月至2009年1月,应用足跗外侧动脉逆行岛状皮瓣修复足前部皮肤缺损患者12例.结果 12例皮瓣均完全成活.随访8 ～ 22个月,平均13个月.皮瓣及皮片质地柔软,色泽与周围正常皮肤相似,外观无臃肿,无需二期皮瓣修整.受区皮瓣感觉以深痛觉为主,皮瓣边缘1 ～2 cm范围有浅触觉和痛觉恢复,即皮瓣边缘感觉为S1 ～S2级.供区皮片有浅触觉和痛觉恢复,未发现皮瓣磨损及破溃,穿鞋无影响,患者步态正常.结论 跗外侧动脉岛状皮瓣对足部的影响较小,是修复足前部软组织缺损的良好选择.     

Reconstruction of a defect fracture of the upper arm using the osteomyocutaneous flap

Summary Reconstruction of an open defect fracture of the upper arm is described. Primary reconstruction by a posteriorly based osteomyocutaneous intercostal transposition flap was used. The soft tissue defect in the triceps area was easily covered by the transposed skin. Except for the radial nerve which was affected by tension, no further major nerve or vessel was damaged. Two months after the first operation the radial nerve was reconstructed by microsurgical neurolysis.     

穿支皮瓣游离移植修复足部创面缺损

目的 探讨应用穿支皮瓣游离移植修复足部创面缺损的临床疗效.方法 2006年3月至2009年12月,应用下肢4种穿支皮瓣游离移植修复20例足部创面缺损患者,男15例,女5例;年龄18～61岁,平均28.5岁;左侧7例,右侧13例.缺损创面部位:足背12例,足跟足底部5例,足踝部3例;创面大小为2.0 cm×3.5 cm～12.0 cm×18.0 cm.皮瓣选择:股前外侧穿支皮瓣5例,股前内侧穿支皮瓣7例,腓浅动脉穿支皮瓣5例,腓动脉穿支皮瓣3例. 结果 本组20例患者皮瓣全部成活,术中2例患者出现血管危象,经及时处理后血运恢复.20例患者术后获3～6个月(平均5.2个月)随访,皮瓣质地、外观均良好,其中13例吻合皮神经恢复了保护性感觉,供区愈合可,功能无影响.结论 应用穿支皮瓣游离移植修复足部创面缺损,临床效果满意,是修复此类创面的较理想选择.     

Mycetoma of the foot — surgical treatment with free flap reconstruction

Mycetoma (Madura foot) is a chronic fungal or bacterial infectious process characterized by a discharging mass. Medical treatment is generally insufficient, and surgical eradication, sometimes by amputation, is advocated. Although a benign disease, the tumor's nature may be considered malignant in view of limb's fate. Reconstruction of a foot with a free tensor fascia lata musculocutaneous flap, following large mycetoma mass resection in a 28-year-old patient is described. A year after surgery, the patient uses the leg without limitation and no recurrence is evident. This limb preservation technique, which enables rapid rehabilitation and ambulation, is superior to amputation.