Arch Hand Microsurg.  2023 Sep;28(3):166-173. 10.12790/ahm.23.0011.

Usefulness of the lateral arm free flap for hand defect reconstruction

• Heo JW
• Chi YJ
• Park HS
• Whang JI

• KMID: 2545527
• DOI: http://doi.org/10.12790/ahm.23.0011

Abstract

Purpose
Although various surgical reconstruction methods are available for multidigit defects or soft tissue defects of the hand, they often require a thin flap due to the hand’s unique physical characteristics. We performed a total of 13 cases of lateral arm free flap surgery at our hospital. The purpose of this study was to report the usefulness of this technique.
Methods
This study included the following cases: four cases of multiple digit amputations, seven cases of hand dorsum skin defects, one case of first web reconstruction due to web contracture, and one case of an index finger bone and soft tissue defect with only the ulnar-side neuro-vascular bundle remaining. After emergency simple debridement, subsequent reconstruction was performed using a lateral arm free flap.
Results
All 13 cases healed without necrosis. Patients who underwent finger amputation were able to preserve the length of their fingers without any additional amputation. Patients who initially had hand dorsum defects were able to maintain grasping function after flap stabilization. The patient with web contracture was able to recover the lost pinching function, and the patient with a combined loss of osteoarticular and soft tissue of the index finger maintained the shape and length of the finger despite the absence of joint function.
Conclusion
The lateral arm free flap is a useful reconstruction method that can be easily performed with a single session of regional anesthesia. Since the flap is thin, it is suitable for hand defect reconstruction. If necessary, vascularized bone grafting is possible.

Keyword

Lateral arm free flap; Microsurgery; Hand reconstruction; Brachial plexus block

Figure

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  Fig. 1. Case 1. (A) Multidigit amputation state due to a presser machine. (B) X-ray image after trauma. (C) Intraoperative photograph of flap harvest. (D) Postoperative photograph of the recipient site. (E) After the first release of the third web space. (F) Postoperative photograph of the recipient site after 6 months.

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  Fig. 2. Case 2. (A) After primary debridement of necrotic tissue in the right hand. (B) Preoperative design of the lateral arm free flap on the right upper arm. (C) Postoperative photograph of the recipient site. (D) Postoperative photograph of the recipient site after 3 months. (E) Postoperative photograph of the donor site after 2 months.

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  Fig. 3. Case 3. (A) Initial X-ray image after trauma. (B) Initial photograph after trauma. (C) Necrosis of the soft tissue on the radial side of the index finger after primary surgery. (D) Intraoperative photograph after harvest of an osteocutaneous lateral arm free flap. (E) Postoperative photograph of the recipient site. (F) Postoperative X-ray image of the recipient site. (G) Postoperative photograph of the recipient site after 5 months (dorsal aspect). (H) Postoperative photograph of the recipient site after 5 months (volar aspect).

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  Fig. 4. Case 4. (A) Initial photograph after trauma. (B) Necrosis of the first web space and volar tissue of the hand after debridement. (C) Intraoperative photograph before harvest of the extended lateral arm free flap. (D) Postoperative photograph of the recipient site (dorsal aspect). (E) Postoperative photograph of the recipient site (volar aspect). (F) Postoperative photograph of the recipient site after 9 months.

Reference

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