The extended lateral arm flap: a detailed anatomical study

The lateral arm flap has long been the workhorse of microvascular surgeons in the cover of small and moderate-sized defects, especially in the head, neck, and the extremities. Its versatility, however, has always been restricted by its small skin paddle. The flap traditionally is harvested from the upper arm. This flap derives its blood supply from cutaneous perforators of the posterior radial collateral artery (PRCA) which forms an anastomotic plexus with the interosseous recurrent artery around the lateral aspect of the elbow. As a result of anatomical dissection and dye injection studies, we have re-defined the cutaneous blood supply of the PRCA which is found to continue for some distance into the forearm, and utilise this finding to design an "extended" lateral arm flap for use in microvascular reconstruction.