Anatomy Overview:

• Robust and reliable fasciocutaneous flap with consistent anatomy, with multiple possible variations, and minimal donor site morbidity. Also – compared to the radial forearm – does not sacrifice a major vessel to the hand.
• Two compartments of the upper arm – anterior and posterior. 
• Anterior contains – Biceps,coracobrachialis, brachialis
• Posterior – Triceps muscle – lateral, medial, long heads 
• These two compartments are separated by lateral and medial intramuscular septums
• Blood supply is the posterior radial collateral artery 
• Profunda brachii divides in to the middle and radial collateral arteries
• Radial collateral artery then divides again into anterior and posterior RCA
• PRCA is our pedicle for the LAF
• PRCA runs within the lateral intramuscular septum, between the lateral head of the triceps and the brachialis/BR
• The flap actually has two venous drainage systems – deep (VCs) and superficial (cephalic)
• The posterior cutaneous nerve of the forearm (or posterior brachiocutaneous nerve) can be used if a sensate flap is desired
• The recurrent radial artery and vein is the blood supply for the reverse lateral arm flap

Topics Covered:

• What are your general thoughts on the lateral arm flap, is it a flap you commonly use? What do you think are some of the advantages/disadvantages?
• How do you like to do your markings for the lateral arm flap? What if you were to do an extended lateral arm flap?
• Do you doppler out your perforators? Which perforators do you prefer to base your skin paddle off of? More proximal or distal?
• Do you use a tourniquet during the entire dissection?
• What are some operative pearls you can share for raising a lateral arm flap? 
• Anterior or posterior incision first?
• Tips for identifying and exposing/protecting the radial nerve and other critical structures?
• Other difficult/tricky parts of the case?
• How long of a pedicle are you typically able to get on average with a traditional lateral arm flap? Do you find this to be a major limitation for something like head and neck recon?
• Donor site closure – STSG vs. primary closure, drain/no drain?
• Can you talk a little bit about how the lateral forearm flap is different than a traditional lateral arm flap? 
• Can you talk to us a little bit about your use of the extended lateral arm flap? Reverse lateral arm flap?
• BONUS QUESTION  – For residents early in training who are interested in reconstructive plastic surgery – What is something you wish you have know as a resident early on that would have helped you in your career?