Arch Hand Microsurg.  2025 Mar;30(1):60-65. 10.12790/ahm.24.0063.

Usefulness of the osteocutaneous lateral arm free flap for small to moderate-sized bone and soft tissue defects of the hand: a report of two cases

• Kim Y
• Park H
• Whang J
• Kim S

• KMID: 2565469
• DOI: http://doi.org/10.12790/ahm.24.0063

Abstract

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Keyword

Lateral arm free flap; Osteocutaneous free flap

Figure

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  Fig. 1. (A) Initial X-ray after trauma. (B, C) Initial photographs. (D, E) Postoperative photography after the first operation (debridement and Kirschner wire fixation). (F, G) Intraoperative photograph (harvest site and after harvest of an osteocutaneous lateral arm free flap). (H) Postoperative photograph of the recipient site. (I) Postoperative X-ray image of the recipient site. (J–L) Postoperative photographs and X-ray of the recipient site after 5 months.

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  Fig. 2. (A) Initial X-ray after trauma. (B) Initial photograph after trauma. (C) Necrosis of the soft tissue on the radial side of the index finger after the first operation. (D) Intraoperative photograph after harvest of an osteocutaneous lateral arm free flap. (E) Postoperative photograph of the recipient site. (F) Postoperative X-ray. (G) Postoperative X-ray after 5 months. (H) Postoperative photograph after 5 months.

Reference

References

1. Song R, Song Y, Yu Y, Song Y. The upper arm free flap. Clin Plast Surg. 1982; 9:27–35. DOI: 10.1016/s0094-1298(20)30370-9. PMID: 7094520.

2. Katsaros J, Schusterman M, Beppu M, Banis JC Jr, Acland RD. The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg. 1984; 12:489–500. DOI: 10.1097/00000637-198406000-00001. PMID: 6465806.

3. Kokkalis ZT, Papanikos E, Mazis GA, Panagopoulos A, Konofaos P. Lateral arm flap: indications and techniques. Eur J Orthop Surg Traumatol. 2019; 29:279–84. DOI: 10.1007/s00590-019-02363-0. PMID: 30649619.

4. Arnez ZM, Kersnic M, Smith RW, Godina M. Free lateral arm osteocutaneous neurosensory flap for thumb reconstruction. J Hand Surg Br. 1991; 16:395–9. DOI: 10.1016/0266-7681(91)90011-c. PMID: 1779151.

5. Heo JW, Chi YJ, Park HS, Whang JI. Usefulness of the lateral arm free flap for hand defect reconstruction. Arch Hand Microsurg. 2023; 28:166–73. DOI: 10.12790/ahm.23.0011.

6. Haas F, Rappl T, Koch H, Pittler P, Scharnagl E. Free osteocutaneous lateral arm flap: anatomy and clinical applications. Microsurgery. 2003; 23:87–95. DOI: 10.1002/micr.10112. PMID: 12740878.

7. Windhofer C, Michlits W, Karlbauer A, Papp C. Treatment of segmental bone and soft-tissue defects of the forearm with the free osteocutaneous lateral arm flap. J Trauma. 2011; 70:1286–90. DOI: 10.1097/ta.0b013e3182095df5. PMID: 21610442.

8. Wong M, Tay SC, Teoh LC. Versatility of the turn-around technique of the lateral arm flap for hand reconstruction. Ann Plast Surg. 2012; 69:265–70. DOI: 10.1097/sap.0b013e3182223e56. PMID: 21734548.