Lateral Arm Flap with Dr. John Shuck

Flap Cast

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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? 

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