A clinical comparison between the radial forearm flap and the lateral arm flap.

Background: Free fasciocutaneous flap transplantation is a versatile method for soft tissue reconstruction. This clinical study points out differencies between the radial forearm flap and the lateral arm flap. Methods: We used the radial forearm flap in 36 patients following tumor ablation and in 11 patients we used the lateral arm flap for soft tissue reconstruction. We studied the arterial and venous vessel calibers of the flaps, the vessel pedicle length, and the size of the skin paddle. Motor and sensory function tests of the upper/lower arm and hand were performed after surgery. Recipient and donor site morbidity was noted. Results: Compared to the forearm flap the lateral arm flap is bulky (1-5 cm vs. 0.5-1.5 cm), its vessel calibers are smaller (Art.: 1.4 vs. 1.8 mm, Ven.: 1.8 vs. 2.0 mm), flap size and maximum vessel pedicle length (10 vs. 12 cm) are equal. Raising the lateral arm flap is more demanding and needs more time due to the deep location of the vessel pedicle and the accompanying radial nerve within the intermuscular septum. On the other hand the lateral arm flap is advantageous because of primary wound closure of the donor site. The donor site of the forearm flap had to be covered with skin graft in all cases. We found sensory deficits of the proximal lower arm in 50% after dissection of the lateral arm flap and in 14% on the distal lower arm and thumb joint after dissection of the radial forearm flap. Conclusions: Both transplants are fasciocutaneous and optional sensate, they offer a constant anatomy and can be harvested simultaneously without interference to the head and neck team. Because of the specific characteristics of these flaps we prefer the radial forearm flap for soft tissue reconstruction. We use the lateral upper arm flap, if a forearm flap cannot be harvested, for head or neck augmentation and for reconstruction of large and deep defects.