Versatility of the turn-around technique of the lateral arm flap for hand reconstruction

The lateral arm flap is a popular flap for hand resurfacing. Despite its many advantages, its use is restricted by the available width of the flap. We describe the application of this long and narrow flap in a turn-around manner, greatly increasing its versatility while achieving primary closure of the donor site. The lateral arm flap was designed with extension onto the forearm (extended lateral arm flap) and harvested in the usual manner. During inset, the distal segment of the flap is brought through a 180 degree "U-turn" to lie adjacent to the proximal segment. We analyzed the outcomes of 31 turn-around lateral arm flaps performed between 1988 and 2008. All flaps healed well without any vascular compromise. Reconstruction of defects with a variety of configurations was performed with a maximum flap size of 144 cm. Four patients required split skin grafting to the forearm. Primary closure of the lateral arm donor site was achieved in all patients. In this article, we demonstrate the ease, reliability, and versatility of this simple modification in extending the usefulness of the lateral arm flap in hand reconstruction.