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General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The lateral arm flap is a type C FC flap that is easy to make sensate. It is based upon the posterior radial collateral artery (PRCA) from the profunda brachii artery (it continues behind the lateral epicondyle to anastomose with the radial artery). The skin island is innervated by the lower lateral cutaneous nerve of the arm, a branch of the radial nerve that pierces the belly of triceps, whilst the upper cutaneous nerve of the arm is a terminal branch of the axillary nerve. There will be an area of numbness along the lateral forearm as a result of flap harvest. The pedicle has a diameter of 1–2 mm with a maximum length of 8 cm (requires some splitting of the lateral head of triceps).
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
Having learned the branches of the axillary artery, it becomes much easier to understand the configuration of the arm and forearm arteries. The continuation of the axillary artery that enters the arm to provide supply to all the arm, forearm, and hand muscles is the brachial artery, which runs on the anterior side of the arm (Plate 4.3). If the body were free from evolutionary and developmental constraints, it would be more logical to have two major arteries, one for each of the two compartments of the arm (anterior and posterior). As this is not the case, the brachial artery has to perform a “trick” to supply to the triceps brachii and the other tissues of the posterior arm: It sends a proximal branch into the posterior arm compartment, as the deep brachial artery (or deep artery of the arm, or profunda brachii artery) (Figure 4.4). This artery courses around the posterior surface of the humerus, where it accompanies the radial nerve in the spiral (radial) groove, and then gives rise to the radial collateral artery that anastomoses with the radial recurrent artery branching from the radial artery (Plate 4.9b). The brachial artery then branches again, more distally, in the middle third of the arm, to give rise to the superior ulnar collateral artery and the inferior ulnar collateral artery. These two collateral arteries anastomose, respectively, with the posterior ulnar recurrent artery and the anterior ulnar recurrent artery branching from the ulnar artery.
Reconstructive Microsurgery in Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
John C. Watkinson, Ralph W. Gilbert
This flap’s blood supply is based on the radial collateral artery of the arm (Figure 93.6). The radial collateral artery arises from the deep brachial artery and runs with the radial nerve on the lateral aspect of the upper arm. Once the radial collateral appears on the anterolateral aspect of the trapezius it divides into a posterior and anterior branch. The anterior branch continues inferiorly to accompany the radial nerve deeply between brachialis and brachioradialis. The posterior branch enters the lateral intermuscular septum between brachialis and triceps and then runs toward the lateral epicondyle. In its course along the lower lateral arm the posterior branch gives off a number of fasciocutaneous perforators to supply the skin in this area. The skin of the lateral arm flap is innervated via the lower lateral cutaneous nerve of the arm a branch of the radial nerve. The innervation provided is relatively dense but not as sensate as the forearm flap.
Clinical management of squamous cell carcinoma of the tongue: patients not eligible for free flaps, a systematic review of the literature
Published in Expert Review of Anticancer Therapy, 2021
Giuseppe Colella, Raffaele Rauso, Davide De Cicco, Ciro Emiliano Boschetti, Brigida Iorio, Chiara Spuntarelli, Renato Franco, Gianpaolo Tartaro
The LAFF is not a popular option among reconstructive head and neck surgeons, even though it has been used for tongue reconstruction with high success rate [44]. The flap provides sufficient bulk to restore the most of tongue defects. Donor site can be closed primarily with minimal scars if the skin paddle does not exceed 6–8 cm in width [44]. Vascular supply is based on the posterior radial collateral artery (terminal branch of the deep brachial artery) that provides a small caliber vessel and short pedicle length [45]. Hence, perhaps, the unpopularity of the flap in its conventional variant. The later introduction of the extended lateral upper arm variant (ELAFF) allowed to overcome most of the earlier limitations [46].
Reverse lateral upper arm flaps for treating large soft tissue defects extending from the elbow to the forearm
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hideki Okamoto, Yohei Kawaguchi, Shinji Miwa, Hisaki Aiba, Hiroya Senda, Satona Murakami, Kazuo Hayakawa, Yuji Joyo, Hideki Murakami, Hiroaki Kimura
When a lateral upper arm flap is taken, the anterior or posterior radial collateral arteries are raised as a pedicle. Song et al. [10] and Katsaros et al. [9] raised the anterior radial collateral artery and posterior radial collateral artery as pedicles, respectively. In 1986, Maruyama and Takeuchi [1] first reported a reverse lateral upper arm flap using a radial recurrent artery. Subsequently, Culbertson and Mutimer [2] described a reverse lateral upper arm flap using the interosseous recurrent artery. Martin et al. [11] and Casoli et al. [12] reported an extended lateral upper arm flap that extended up to the distal forearm and wrist. Morrison et al. [4] reported a two-stage reverse lateral upper arm flap based on the radial recurrent artery for coverage of complex traumatic elbow injuries. Herein, the authors elevated the flap and reinset it in its native position and sutured at the skin level. After at least 15 days, the flap was transferred to the elbow wound being treated. Ashfaq et al. [5] used at the reverse lateral upper arm flap to cover elbow defects caused due to burns. The flap sizes ranged from 9 × 5 cm to 15 × 6 cm, and the fasciocutaneous distal base was left intact [5]. In our cases, we implanted a reverse lateral upper arm flap using the interosseous recurrent artery. We succeeded in preserving the retrograde blood flow from the interosseous recurrent artery and covering large skin defects around the elbow and forearm by using a reverse lateral upper arm flap to create a pedicled flap, as described in the reports by Ashfaq et al. [5] and di Summa et al. [13], instead of an island flap. A skin bridge was maintained over the pedicle at the distal margin of the flap to improve the venous drainage in all cases.
Case report: reverse lateral arm flap in a patient with previously harvested radial artery
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Zahir T. Fadel, Mohammed B. Ashi, Weaam S. Magram
The posterior edge of the flap was incised and the dissection was carried down to the sub-fascial plane towards the lateral intermuscular septum. Two septocutaneous perforators were identified and preserved. The pedicle was dissected free from the surrounding tissue and nerves, protecting the radial nerve and posterior cutaneous nerve of the arm (Figure 3). The proximal end of the radial collateral artery (RCA) was ligated, leaving an adequate length for potential supercharge if necessary.