The lateral arm flap is a useful free flap for head and neck reconstruction due to the following advantages: there is no need to sacrifice an artery that may be essential to the vascularity of the distal upper extremity (as compared to the radial forearm free flap), and in many patients it is possible to close the donor defect primarily.66-68

Figure 18-23. A, Design of radial forearm free flap. B, Flap elevated on radial artery pedicle. C, Defect after composite resection of lateral floor of mouth and marginal mandibulectomy which is suitable for reconstruction using this flap.
Figure 18-24. Radial forearm free flap with two skin islands used for external skin and intranasal reconstruction.

The lateral arm free flap may be transferred either as a fascial or fasciocutaneous flap based on the posterior radial collateral artery, a terminal branch of the profunda brachii artery. The vascular pedicle runs parallel to the lateral intermuscular septum and anastomoses with the recurrent interosseous artery distally. The maximum dimensions of the cutaneous paddle are 18 x 11 cm; however, in most cases the width of the flap is limited to 6 to 8 cm, in order to allow primary closure of the posterior aspect of the arm (Figure 18-27). The skin paddle is moderately pliable and the recovery of sensation is made possible by anastomosing the posterior cutaneous nerve of the arm to a recipient nerve in the head and neck. This sensate lateral arm flap has been used for restoration of the oral cavity and for partial glossec-tomy defects.60,68 In addition, the lateral arm flap is used to resurface facial defects and less often for through and through cheek defects.67

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