Donor-Site Morbidity of the Sensate Extended Lateral Arm Flap
ABSTRACT The free extended lateral arm flap (ELAF) has gained increasing popularity thank to its slimness and versatility, longer neurovascular pedicle, and greater flap size when compared with the original flap design. The aim of this study was to assess the donor-site morbidity associated with this extended procedure. A retrospective study of 25 consecutive patients analyzing postoperative complications using a visual analogue scale questionnaire revealed high patients satisfaction and negligible donor-site morbidity of the ELAF. Scar visibility was the commonest negative outcome. Impaired mobility of the elbow had the highest correlation with patient dissatisfaction. Sensory deficits or paresthetic disorders did not affect patient satisfaction. The extension of the lateral arm flap and positioning over the lateral humeral epicondyle is a safe and well-accepted procedure with minimal donor-site morbidity. To optimize outcomes, a maximal flap width of 6 or 7 cm and intensive postoperative mobilization therapy is advisable.
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ABSTRACT: The lateral upper arm flap (LUAF) was initially described by in 1982 by Song et al. as a simple skin flap, addressing the availability of cutaneous nerves for anastomoses. Katsaros et al., reported the use of a lateral upper arm skin flap, but also considered using it as a composite graft. The LUAF for the oral and maxillofacial reconstruction has several advantages over other flaps, such as constant anatomy, good color match and texture, thin design and plasticity. There is no functional limitation in the donor arm, such as strength and extension, and donor defects can be closed primarily with a linear scar, even when a flap of up to 8 cm in width is taken. For a better understanding of LUAF as a routine reconstructive option in moderate defect of maxillofacial region, the constant anatomical findings must be learned and memorized by young doctors during the specialized training course for the Korean national board of oral and maxillofacial surgery. This article review the anatomical basis of LUAF with Korean language.01/2012; 34(4).
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ABSTRACT: There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves "untreated". Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.Neural Regeneration Research 10/2012; 7(29):2279-85. DOI:10.3969/j.issn.1673-5374.2012.29.006 · 0.22 Impact Factor
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ABSTRACT: Background The authors presented their clinical experience and demonstrated surgical methods for reconstructing complex bone and soft tissue defects of the hand by using modified chimeric radial collateral artery perforator flaps. Methods Surgical procedures that employed 16 modified chimeric radial collateral artery perforator flaps and 3 dual paddle flaps were performed in 16 patients. Among the patients, eight had defects in the metacarpal bones and eight had defects in the phalanx bones. The flaps were created with a skin paddle and humeral bone segments by using independent perforators. The flaps ranged in size from 5.5 × 2.0 to 7.5 × 4.5 cm, whereas the humeral fragments ranged in size from 1.5 × 0.5 to 4.0 × 1.5 cm. The pedicle of the flaps was divided and ligated below the level at which the radial collateral artery separates into anterior and posterior branches. The recipient vessels were the proper digital artery, the palmar subcutaneous vein (n = 12), the deep branch of the palmar ulnar artery (n = 4), and the venae comitantes. The cosmetic appearance of both donor and recipient sites was evaluated during a follow-up visit. Results Postoperative venous congestion occurred in two cases. The venous obstruction was reanastomosed after venous thrombectomy. The procedures were successful in both cases upon examination. All the flaps survived and all the donor sites were closed directly, leaving only a linear scar. Follow-up time ranged from 12 to 28 months. Bone components achieved union in all cases at an average of 5.4 months (ranging from 3 to 6 months). In two cases, the flap was defatted during the late postoperative period. Cosmetically acceptable results were achieved for the rest of the patients. Conclusion The modified chimeric radial collateral artery perforator flap is a good alternative for reconstructing complex bone and soft tissue defects of the hands. Level of Evidence This is a level IV, retrospective series.Journal of Reconstructive Microsurgery 10/2014; 31(03). DOI:10.1055/s-0034-1390324 · 1.31 Impact Factor