The distally based lateral arm flap for intraoral soft tissue reconstruction

The radial forearm flap is probably the most frequently used among free flaps for intraoral soft tissue reconstruction. However, this flap is not always available. The other fasciocutaneous flaps may be too bulky or less pliable or may have a short vascular pedicle; their use is therefore less than ideal. We present a variant of the lateral arm flap located distally to the lateral epicondyle and having the same advantages as the radial forearm flap.

Vascular study (dissection and radiography) was previously undertaken to determine the vascular anastomotic network in the epicondylar area, between the posterior radial collateral artery and recurrent arteries running in front of the lateral epicondyle. This demonstrated the possibility of taking a skin paddle on and below the lateral epicondyle, based on the proximal pedicle.

We used this flap on three patients for intraoral soft tissue reconstruction (tonsil, floor of the mouth, and piriform sinus). No complication with the flap itself was encountered. In all cases, direct closure of the donor site was possible, with no local complication.

The distal lateral arm flap (LAF) represents an interesting and reliable alternative to the fasciocutaneous radial forearm flap. The positioning of the skin paddle over the lateral epicondyle and the proximal third of the lateral aspect of the forearm increases pedicle length, thus avoiding the use of vein grafts. Dissection is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures easier placement and more pliability when compared with the standard LAF.