Osteocutaneous lateral arm flap in hand reconstruction

Complex injuries of the hand often have severe soft tissue damage and associated intercalary segmental or distal loss of bone. Bone grafting to restore the skeletal scaffold is essential for soft tissue reconstruction. With a poor vascular bed, non-vascularised free bone grafts are not desirable. We describe 14 cases of vascularised humeral bone grafting for these difficult reconstructions. The bone was harvested as an osteocutaneous lateral arm flap. Constant osseous branches from the main pedicle of the posterior radial collateral artery which travel along the lateral intermuscular septum to the bone were preserved. Humeral bone grafts as a composite with the lateral arm flap are able to provide 1.5 x 10 cm of well vascularised bone for hand reconstruction. All 14 flaps survived and X-rays of the graft at 3 to 6 months showed consolidated bony union with little or no bony resorption.