Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(02): 144-151
DOI: 10.1055/s-0041-1729507
Original Article

Function-Preserving Neurotized Lateral Arm Free Flap in the Reconstruction of Hemiglossectomy Defects

Divya Prakash
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India
,
T. M. Balakrishnan 
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India
,
J. Jaganmohan
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction and Methods The glabrous, thin, and pliable texture of lateral arm flap with no loss of any axial vessel of the limb renders it a good choice for hemiglossectomy defect reconstruction. The main caveat of this flap harvest is the loss of sensation in the distribution of posterior antebrachial cutaneous nerve (PABCN). In this article, we present two strategic sites and techniques to preserve the integrity of PABCN and at the same time harvesting lateral arm flap with a lengthy lower lateral cutaneous nerve of arm for the neurotization. The outcome of this function-preserving neurotized lateral arm free flap in the reconstruction of hemiglossectomy defects is analyzed and presented in this article.

Results Ninety percent of the patients attained grade 3 score in objective assessment, leading to a significant p-value of 0.02 with this technique. All had preservation of sensation in the distribution of PABCN.

Conclusion Our technique of harvest and neurotization has brought good functional recovery of the oral cavity with preservation of PABCN.

Keywords

lateral arm flap - neurotized flap - posterior antebrachial cutaneous nerve - fascicular dissection - hemiglossectomy


Publication History

Article published online:
23 June 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Song R, Song Y, Yu Y, Song Y. The upper arm free flap. Clin Plast Surg 1982; 9 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 2 Graham B, Adkins P, Scheker LR. Complications and morbidity of the donor and recipient sites in 123 lateral arm flaps. J Hand Surg [Br] 1992; 17 (02) 189-192
    CrossrefPubMedGoogle Scholar
  • 3 Fogdestam I, Tarnow P, Kalaaji A. Extended free lateral arm flap with preservation of the posterior cutaneous nerve of the forearm. Scand J Plast Reconstr Surg Hand Surg 1996; 30 (01) 49-55
    CrossrefPubMedGoogle Scholar
  • 4 Ki SH. Lateral arm free flap with preservation of the posterior antebrachial cutaneous nerve. Ann Plast Surg 2016; 76 (05) 517-520
    CrossrefPubMedGoogle Scholar
  • 5 Ho JH. University of Washington quality of life questionnaire. In: Michalos AC, ed. Encyclopaedia of Quality of Life and Well-Being Research., Dordrecht, Netherlands Springer 2014
  • 6 Boyd B, Mulholland S, Gullane P. et al. Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense?. Plast Reconstr Surg 1994; 93 (07) 1350-1359
    CrossrefPubMedGoogle Scholar
  • 7 Namin AW, Varvares MA. Functional outcomes of sensate versus insensate free flap reconstruction in oral and oropharyngeal reconstruction: a systematic review. Head Neck 2016; 38 (11) 1717-1721
    CrossrefPubMedGoogle Scholar
  • 8 Thankappan K, Kuriakose MA, Chatni SS. et al. Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome. Ann Plast Surg 2011; 66 (03) 261-266
    CrossrefPubMedGoogle Scholar
  • 9 Brown JS, Rogers SN, Lowe D. A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes. Int J Oral Maxillofac Surg 2006; 35 (03) 208-214
    CrossrefPubMedGoogle Scholar
  • 10 Shpitzer T, Guttman D, Gur E, Feinmesser R, Ad-El D. Transoral reconstruction of the mobile tongue, using radial forearm free flap. Microsurgery 2003; 23 (01) 18-20
    CrossrefPubMedGoogle Scholar
  • 11 Hsiao HT, Leu YS, Lin CC. Tongue reconstruction with free radial forearm flap after hemiglossectomy: a functional assessment. J Reconstr Microsurg 2003; 19 (03) 137-142
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Kuriakose MA, Loree TR, Spies A, Meyers S, Hicks Jr WL. Sensate radial forearm free flaps in tongue reconstruction. Arch Otolaryngol Head Neck Surg 2001; 127 (12) 1463-1466
    CrossrefPubMedGoogle Scholar
  • 13 Richardson D, Fisher SE, Vaughan ED, Brown JS. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg 1997; 99 (01) 109-115
    CrossrefPubMedGoogle Scholar
  • 14 Katsaros J, Schusterman M, Beppu M. Banis JC Jr, Acland RD. The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg 1984; 12 (06) 489-500
    CrossrefPubMedGoogle Scholar
  • 15 Matloub HS. et al. The lateral arm flap. A neurosensory free flap. In: Williams HB, ed. Transactions of the VIII International Congress of Plastic Surgery.. Montreal, Canada: IPRS; 1983; 125
    Google Scholar
  • 16 Nahabedian MY, Deune EG, Manson PN. Utility of the lateral arm flap in head and neck reconstruction. Ann Plast Surg 2001; 46 (05) 501-505
    CrossrefPubMedGoogle Scholar
  • 17 Wax MK, Briant TD, Mahoney JL. Lateral-arm free flap for reconstruction in the head and neck. J Otolaryngol 1996; 25 (03) 140-144
    PubMedGoogle Scholar
  • 18 Wenig BL. The lateral arm free flap for head and neck reconstruction. Otolaryngol Head Neck Surg 1993; 109 (01) 116-119
    CrossrefPubMedGoogle Scholar
  • 19 Sullivan MJ, Carroll WR, Kuriloff DB. Lateral arm free flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1992; 118 (10) 1095-1101
    CrossrefPubMedGoogle Scholar
  • 20 Akinci M, Ay S, Kamiloglu S, Erçetin O. Lateral arm free flaps in the defects of the upper extremity—a review of 72 cases. Hand Surg 2005; 10 (02/03) 177-185
    CrossrefPubMedGoogle Scholar
  • 21 Ulusal BG, Lin YT, Ulusal AE, Lin CH. Free lateral arm flap for 1-stage reconstruction of soft tissue and composite defects of the hand: A retrospective analysis of 118 cases. Ann Plast Surg 2007; 58 (02) 173-178
    CrossrefPubMedGoogle Scholar
  • 22 Kim CH, Tark MS, Choi CY, Kang SG, Kim YB. A single-stage reconstruction of a complex Achilles wound with modified free composite lateral arm flap. J Reconstr Microsurg 2008; 24 (02) 127-130
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Haas F, Seibert FJ, Koch H. et al. Reconstruction of combined defects of the Achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous lateral arm flap. Ann Plast Surg 2003; 51 (04) 376-382
    CrossrefPubMedGoogle Scholar
  • 24 Song XM, Yuan Y, Tao ZJ, Wu HM, Yuan H, Wu YN. Application of lateral arm free flap in oral and maxillofacial reconstruction following tumor surgery. Med Princ Pract 2007; 16 (05) 394-398
    CrossrefPubMedGoogle Scholar
  • 25 Kokkalis ZT, Papanikos E, Mazis GA, Panagopoulos A, Konofaos P. Lateral arm flap: indications and techniques. Eur J Orthop Surg Traumatol 2019; 29 (02) 279-284
    CrossrefPubMedGoogle Scholar
  • 26 Gellrich NC, Schramm A, Hara I, Gutwald R, Düker J, Schmelzeisen R. Versatility and donor site morbidity of the lateral upper arm flap in intraoral reconstruction. Otolaryngol Head Neck Surg 2001; 124 (05) 549-555
    CrossrefPubMedGoogle Scholar
  • 27 Alcalde Navarrete J, Pastor MJ, Quesada JL. et al Reconstruction of oropharyngeal defects with lateral arm flap [in Spanish] Acta Otorrinolaringol Esp 2001; 52 (01) 39-44
    CrossrefPubMed
  • 28 Lanzetta M, Bernier M, Chollet A, St-Laurent JY. The lateral forearm flap: an anatomic study. Plast Reconstr Surg 1997; 99 (02) 460-464
    CrossrefPubMedGoogle Scholar
  • 29 Marques Faria JC, Rodrigues ML, Scopel GP, Kowalski LP, Ferreira MC. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg 2008; 61 (02) 172-179
    CrossrefPubMedGoogle Scholar
  • 30 Hara I, Gellrich NC, Duker J. et al. Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap. Br J Oral Maxillofac Surg 2003; 41 (03) 161-169
    CrossrefPubMedGoogle Scholar
  • 31 Civantos Jr FJ, Burkey B, Lu FL, Armstrong W. Lateral arm microvascular flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1997; 123 (08) 830-836
    CrossrefPubMedGoogle Scholar
  • 32 Reinert S. The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg 2000; 28 (02) 69-73
    CrossrefPubMedGoogle Scholar
  • 33 Balakrishnan TM, Jayachandiran AP, Hariraj DD, Jaganmohan J. Chimeric anterolateral thigh flap for primary functional reconstruction of complex, composite near total hemi facial post excision defects. J Craniofac Surg 2020; 31 (04) e337-e343
    CrossrefPubMedGoogle Scholar
  • 34 Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg 1998; 118 (05) 616-624
    PubMedGoogle Scholar