Lateral Arm Free Flap for Head and Neck Reconstruction

Introduction: The lateral arm free flap is not frequently utilized for head and neck reconstruction despite similar fasciocutaneous properties as the radial forearm flap with less donor-site morbidity. Outcomes are limited with current institutional series composed of 2-48 patients.

Methods: A retrospective review was conducted of all patients who underwent lateral arm free autologous tissue transfer for head and neck reconstruction at a tertiary care center over a decade (2012-2022). Donor-site assessment was performed using the Disabilities of the Arm, Shoulder, and Hand Questionnaire. Anatomic descriptions of the lateral arm, extended lateral arm, and lateral forearm are provided.

Results: 160 patients (52% female) with a median age of 63 years (range 13-92) and BMI of 27 (range 17-60) were followed for a median of 18 months (range 4-109). Defects were 68% oral cavity (43% glossectomy, 10% maxilla, 10% buccal 7% floor of mouth), 27% cutaneous/parotid, and 5% pharyngeal. The median (range) skin paddle length, width, and thickness were 8 cm (4-20), 5 cm (3-8), and 0.5 cm (0.3-1.2), respectively. The median pedicle length was 11.9 cm (range 5-16). The median artery and vein diameter were 1.6 and 2.7 mm, respectively. All donor sites were closed primarily with one dehiscence. Recipient arteries included 48% facial, 34% superior thyroid, 11% superficial temporal, 5% lingual, and 2% other. Hospitalizations were a median (±standard deviation) 7±2.7 days. Complications occurred in 16% of patients, including 6.3% 30-day reoperation, 6.9% 30-day readmission, 3.7% fistula, 1.9% flap loss, and 1.9% donor-site paresthesia. One patient experienced transient radial neuropraxia, but no patients had decreased postoperative grip strength. Flap revision was performed for 20% of patients, and 62% of patients received adjuvant radiation. Last diet was exclusively oral for 88.5% of oral cavity patients.

Conclusions: In the largest single-institution review, the lateral arm free flap provided a safe, versatile, and reliable option for mucosal and cutaneous defects. Donor sites were closed primarily with a single transient radial neuropraxia.