Flaps for Elbow cover Procedures. The lateral arm flap is designed with its longitudinal axis on this marking. The flap can be used for covering various soft tissue defects around the elbow in a single stage with acceptable donor site morbidity. Largest defect of scalp that can be . The flap, which is raised at the lateral aspect of the upper arm, is perfused by the terminal branches of the profunda brachii artery. Numerous techniques and flaps have been suggested for the surgical treatment of elbow flexion contractures: Z-plasty 2-5; Y-V plasty and its modifications 6-9; seven-flap plasty 10; x-plasty 11; propeller flap 12, 13; rhomboid flap 14, 15; squere flap 16; bipedicle flap 17; distal pedicled reversed upper arm flap, reverse lateral arm flap, rotated fasciocutaneous and musculocutaneous flaps 18 . LATERAL KOL FLEB, DISTALLY BASED LATERAL ARM FLAP, PLEASE NOTE RADIAL NERVE AND POSTERIOR ANTEBRACHIAL CUTANEOUS NERVE, RADAL SNR VE POSTEROR ANTEBRACH. Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. Lateral arm defects. Soft-Tissue Coverage of the Elbow; Clinical Experience with the Reverse Lateral Arm Flap in Soft-Tissue Coverage of the Elbow; Ear Deformities, Otoplasty, and Ear Reconstruction; Soft-Tissue Coverage of the Elbow; Surgical Correction of Gynecomastia Blood supply by posterior radial collateral artery (branch of profunda brachii) Latissimus Dorsi myocutaneous flap. Based on the posterior radial collateral artery (PRCA) and the septocutaneous perforators The flap provides the skin from the distal posterior . Clinical experience with the reverse lateral arm flap in soft-tissue coverage of the elbow. Procedure 47 Lateral Arm Flap for Upper Limb Coverage Lam-Chuan Teoh Indications Procedure is used for soft tissue defects of the hand and wrist. Post. PMID: 8497540 Abstract A technique for coverage of periolecranon (elbow) defects is presented. Reverse lateral arm flap is one of the few local options available with good colour and contour match and no sacrifice of major blood vessel. Since the flap's description by Song et al. The later, Our website uses cookies to enhance your experience. The pedi- cled latissimus dorsi flap maintains the vascular pedicle outside of the zone of injury, allows early range of motion of the elbow, and can be done under loupe magnification requiring no microsurgical skills or equip- ment. Other options include the pedicled radial forearm flap and the reverse lateral arm flap, which can also be raised as a perforator-based radial collateral artery perforator (RCAP) flap. 1). Flaps for Forearm cover Procedures. The latissimus dorsi muscle flap has been a workhorse regional pedicled flap for elbow coverage. interosseous artery flap 19. The types of flaps done from abdomen to the elbow region is shown in Table 1. The . Lateral arm flap. Estudo clnico do retalho lateral do brao ampliado A clinical study of the extended lateral arm flap . Reverse lateral arm flap is one of the few local options available with good colour and contour match and no sacrifice of major blood vessel. The take rate for . The flap can be designed with a 6-8 cm width, which allows primary closure of the wound. Coverage of soft-tissue defects of the posterior aspect of the elbow is a difficult problem. Useful for metaphyseal reconstruction. Extensive defects between the shoulder and elbow area are technically challenging with limited reconstructive options. The . 2007-10-09 00:00:00 The lateral arm flap is a versatile fasciocutaneous flap that may be used locally on the upper extremity or as a microvascular free flap. Flaps for Dorsal Hand cover Procedures. Dtails; Contenu; Titre: Clinical experience with the reverse lateral arm flap in soft-tissue coverage of the elbow; Auteur . A technique for coverage of periolecranon (elbow) defects is presented. There were rare The technique improves local angiogenesis, reduces wound size and provides a secure, sterile wound coverage. Defects around the elbow can be reconstructed with the radial recurrent artery flap or a proximal based radial forearm flap [2]. The majority of the patients were satisfied with the underwent defect coverage of the forearm and hand with the aesthetic result at the recipient site as well as at the donor site. Axial flap that has been a mainstay of providing soft-tissue coverage of the upper extremity. Methods . This procedure allows for a skin flap that can be up to five centimeters wide and span from the lateral epicondyle to the insertion of the deltoid muscle. We used the composite lateral arm free flap in 6 patients, 3 with triceps muscle and 3 with triceps tendon. There has been few clinical series describing its use. 9/15/2020 5 GROIN FLAP TEXT ABDOMINAL FLAPS PIA 13 14 15. Reverse pedicled lateral arm flap. A chimeric myocutaneous or osteomyocutaneous ap was used to con-trol chronic infection or ll the dead space of a lesion, if nec-essary. Five patients were operated on as emergencies, 12 were operated within the first 72 . The lateral arm flap is located on the lateral aspect of the upper arm and is supplied by the posterior radial collateral artery. This study is aimed at utilizing the advantages of this flap to validate its increased applications for foot and ankle defects. can provide vascularized bone and sensate skin paddle; Dominant pedicle is posterior radial collateral artery (septate perforators from profunda brachii between deltoid tubercle and epicondyle), and posterior brachial cutaneous nerve (C5-C6 ), 7-12cm, large amounts of bone can be harvested The arc of transposition of the LD flap depends on the location of the wound. It is best suited to cover small defects along the anterolateral and Surgeons perform the free lateral arm flap procedure when there is a defect in skin coverage of the forearm or hand that necessitates fat and skin coverage. Used for medial and midline defects over proximal third of tibia. Lateral arm flap: fasciocutaneous flap for small to medium sized soft tissue defects of hand, forearm, elbow. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. A lateral arm free flap was first described by Katsaros et al. Cite . The groin flap used to be the workhorse flap for hand reconstruction, but it has been supplanted by the use of regional flaps (radial forearm and posterior interosseous artery) and free skin flaps (lateral arm and anterolateral thigh). We suggest . Many options exist for reconstruction of the posterior elbow/olecranon area following wound formation. Tung et al.illustrated a full range of movement and healing using reversed lateral flaps for elbow soft tissue coverage in seven patients [26]. In our series we used a perforator-based medial transposition flap (Figures 1(a) and 3) and a perforator-based lateral forearm flap (Figures 1(b) and 4). Latissimus Dorsi Flap This flap is extremely useful for the arm as a pedicled anterior or posterior arm and elbow [27-29]. Blood supply provided by perforators off of the thoracodorsal artery. In this study, we report three cases wherein reverse lateral upper arm flaps were used to treat very large tissue defects extending from the elbow to the forearm. If the width is larger, the donor . The extensive continuing anatomical study (5, 6) of the vascular territories of the forearm skin and the demonstration of the clinical applicability of the proximally based fasciocutancous forearm flaps provided a highly efficient means for coverage of skin defect around the elbow. 5. REVERSE LATERAL ARM FLAP 10 11 12. Medial Gastroc flap. Operative technique is discussed. The lateral arm flap, in its pedicular or retrograde form, has limitation of coverage for the proximal region of the forearm. free lateral arm flap. Table indicates type of flaps and individual dimensions. If the size of the defect was large, an extended ap cover-ing the distal portion of the elbow level was used. Complete coverage of composite defects was achieved with a single surgical procedure in all patients. 80% of cases. latissimus dorsi flap. Flaps for Thumb reconstruction Procedures. Twenty patients with various LAF types between May 2011 and May 2020 were enrolled. The most common flaps used for this area include the reversed lateral arm, latissimus dorsi, brachioradialis, flexor carpi ulnaris, radial forearm, and local perforator-based cutaneous flaps. Background:Flap coverage is superior to graft for elbow defects secondary to burns to preserve range of motion. The mean patient age was 48 years Conclusion The free lateral arm flap is a very reliable option (17-78). The reverse lateral arm adipofascial flap covered immediately with a skin graft has been used successfully for reconstruction of a cubital fossa defect and an exposed olecranon in 2 patients. With appropriate repair, most likely functional outcome of rectus femoris myocutaneous flap? The expanded flap easily can reach the xiphoid. The reverse lateral arm adipofascial flap covered immediately with a skin graft has been used successfully for reconstruction of a cubital fossa defect (caused by avulsion injury) and an exposed olecranon . More recently, freestyle perforator flaps have broadened the options for soft tissue reconstruction 1. chinese flaps shang-ti-shen ruyao song 1982 yang kuo-fan. Based on deep circumflex iliac vessels. The technique uses the local tissues of the lateral upper arm as an axial flap and minimizes the donor defect for this type of reconstruction by obviating the need for a skin graft. Citations & impact Impact metrics 14 Article citations Jump to Citations Background: The posterior interosseous artery (PIA) flap has been widely reported to cover defects at the dorsal aspect of the hand. Flap coverage is superior to graft for elbow defects secondary to burns to preserve range of motion. We describe a case of a free-style . less morbid and more reliable option is islanded fasciocutaneous flaps-lateral arm and thoracodorsal perforator flaps [4]. . A sensate, fasciocutaneous flap for cover of posterior elbow defects is described. In this article, the authors describe a series of 8 cases of reverse lateral arm flap used to cover defects about the elbow.They advocate an islanded design, and they begin their dissection posteriorly.Outcomes with respect to the flap and elbow range of motion are detailed.A reverse flow medial upper arm flap is also discussed. It has a large arc of rotation and robust pedicle providing coverage of moderate to large soft tissue defects of the elbow, however, beyond the olecranon the latissimus dorsi . Usually, four to five centimeters are the widest a flap can be. The lateral arm flap The lateral arm flap Pidhorz, C.; Howard, A.; Lipton, J. 19 20. 9/15/2020 6 RADIAL FOREARM AND IT'S MANY ITERATIONS FDMA REVERSE LATERAL ARM FLAP 16 17 18. The flap sizes were 19 6.5 cm, 2. A case report is presented in which a double skin flap was used to cover a large defect (408 cm) extending from the lateral humeral condyle to the dorsal aspect of the hand. Lateral arm perforator island advancement flap is a good alternative for a propeller flap for coverage of soft-tissue defects of the posterior elbow. ELBOW AND ARM SOFT TISSUE RECONSTRUCTION Lateral arm flap Latissimus dorsi flap 20. During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed. Coessens B(1), Vico P, De Mey A. There has been few clinical series describing its use. The aim of this study is to describe its usefulness in both acute and post burn deformities for . Author information: (1)Department of Plastic Surgery, Free University of Brussels, Belgium. The mean time of flap reconstruction was 14 days (range 5-29). This flap provides coverage that is thin and supple and that allows subsequent elevation for secondary procedures. in 1982 [1], its ease of harvesting and the constancy of its vascular pedicle have made the lateral arm free flap . Clinical experience with the reverse lateral arm flap in soft-tissue coverage of the elbow. These defects range from a medium size of 3 5 cm to a large size of 15 20 cm and can include the following: Soft tissue defect from traumatic injuries Soft tissue defect from infections The flap can be quite long however, from the deltoid insertion to distal to the lateral epicondyle. The results of 10 consecutive fasciocutaneous transposition lateral arm flaps for coverage of posterior elbow wounds are reported. This artery is not essential for the vascularity of the extremity. The distal skin overlying the lateral humeral epicondyle and elbow in most individuals is quite thin. However, the use of this flap to cover elbow defects has been rarely reported. latissimus dorsi flap. Based on the superficial circumflex iliac artery. The most common axial fasciocutaneous flap for elbow coverage in the literature is the radial forearm flap . The free lateral arm flap (LAF) is an alternative to conventional flaps and has been widely used due to advancements in its flap characteristics. The posterior or lateral brachial cutaneous nerve was Baltimore Therapeutic Evaluation testing in those patients where triceps tendon was harvested showed no deficit in elbow extension. Publication types Case Reports The drawbacks . lateral arm flap: anatomy. Lateral arm flap It is local pedicled fasciocutaneous flap. It possesses a consistent axial pedicle, and is relatively straightforward to elevate and inset in one stage. Lateral arm perforator island advancement flap is a good alternative for propeller flaps for covering posterior elbow soft-tissue defects wider than 6 cm at the short axis and not longer than 5 cm at the long axis. The lateral arm perforator flaps for elbow soft-tissue coverage have a propeller design. Reverse lateral arm flap may be elevated on the distal pedicle but cannot provide enough bulk to reconstruct larger defects around the elbow.23The brachioradialis flap has been described in case studies for use of coverage around elbow. We describe our experience using this flap in staged operations. 8/31/2020 1 Flap Coverage in the Thumb and Digits Harvey Chim, MD FACS Associate Professor Division of Plastic and Reconstructive Surgery . The purpose of this study was to . shoulder can be reconstructed using a lateral arm flap [1]. Flaps for Wrist cover Procedures. Flaps for Cover of the Palm Procedures. Coverage of soft-tissue defects of the posterior aspect of the elbow is a difficult problem. The lateral arm derives its blood supply from the posterior radial collateral artery when used as a free flap or from the recurrent radial collateral artery when utilized as a reversed flow pedicled flap. Clinical data was . Various flaps were utilized for coverage of elbow defects. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Abstract. By Renato Ribeiro Gonalves, lvaro Baik Cho, Fabiano Incio de Souza, Marcelo Rosa de Rezende, Luciano Ruiz Torres, Rames Mattar Junior and Arnaldo Valdir Zumiotti. In this study, for the first time, we report three cases wherein reverse lateral upper arm flaps were used to treat very large soft tissue defects extending from the elbow to the forearm after wide resection of a malignant tumor or severe trauma. Bone Flaps. Risk of injury to lateral femoral cutaneous nerve. The flap is innervated by the lower lateral cutaneous nerve of the arm. Leg Muscle Flaps. It was first described in 1982, and till then, even more clinical applications are suggested. Local and regional options are preferred methods for soft tissue coverage in this region. This portion is applicable for palmar resurfacing. It is now commonly used in upper extremity reconstruction, both as a reverse pedicle and as a free flap. Lateral arm perforator island advancement flap is a good alternative for a propeller flap for . Early clinical series document a number of application possibilities, especially in the head and neck area [ 107, 109, 349, 483, 494, 577 ]. The flap is simple to raise and can be rot. The lateral arm flap is our preferred free flap for reconstruction of large defects. However, it continues to be a safe and reliable alternative for primary coverage of wounds on the hand . In this report, we describe a case of posterior elbow defect that was reconstructed with posterior radial collateral artery perforator island advancement flap. region allows the lateral arm flap to be used a 'reverse lateral [26]. Skip to main content. Further, additional information . Flaps for Web reconstruction Procedures. A pedicled latissimus dorsi muscle flap or musculocutaneous flap may cover such defects . The skin of the arm is pinched to judge the maximum with of the flap is a large paddle is needed. The lateral arm fasciocutaneous free flap is a versatile donor site of sensate soft tissue for reconstruction and augmentation of the head and neck. Purpose: The pedicled reverse-flow lateral arm flap has been described primarily for the reconstruction of nontraumatic elbow wounds. The flap is disconnected from its blood supply at the distal portion and elevated . Lateral arm flap, medial arm flap, and Z-plasty were used in two, two and five patients, respectively. par Coessens, Bruno;Vico, Pierre ;De Mey, Albert Rfrence Plastic and reconstructive surgery, 92, 6, page (1133-1136) Publication Publi, 1993. Lateral arm perforator flap as an island advancement flap for posterior elbow soft-tissue reconstruction. It has been described as reverse-flow and as perforator propeller flap (radial collateral artery perforator [RCAP]). In our case, vacuumassisted closure was used for temporary coverage of the elbow defect. Common flap options include the reversed lateral arm flap, the radial forearm flap, posterior . This was followed by various fasciocutaneous flaps. 15-Degree extensor lag of the knee. The technique uses the local tissues of the lateral upper arm as an axial flap and minimizes the donor defect for this type of reconstruction by obviating the need for a skin graft. Pedicle supplied by . Arm Flaps. lateral . The flap elevation technique on the lateral side of the elbow, a position that is more distal than usual, is not suf-ficient to cover a distal lesion. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue, [Skip to Navigation] Donor up to 12x6cm closed primarily. large elbow defects. The technique uses the local tissues of the lateral upper arm as an axial flap and minimizes the donor defect for this type of reconstruction . Does not sacrifice major artery to the hand. Small elbow and arm defects can be covered using a proximal based radial forearm [ 23 ]. The usefulness of reverse lateral upper arm flaps for elbow coverage has been reported, however, in most studies, these flaps have been used for small soft tissue defects in most studies . Latissimus dorsi flap, either as a muscle or myocu - taneous, was by far the most common flap used for elbow coverage from the abdomen. provides full-thickness soft-tissue coverage for defects about the elbow. 9/15/2020 7 ROTATIONAL AND ADVANCEMENT FLAPS THANK YOU! The lateral arm flap (LAF) represents an attractive option for elbow reconstruction, due to low donor site morbidity and a consistent surgical anatomy. It is based on the posterior radial collateral artery. In this report, we describe a case of posterior elbow defect that was reconstructed with posterior radial collateral artery perforator island advancement flap. The anterolateral thigh flap has recently received attention [20, 22-24] from hand surgeons and now represents a good alternative to other fasciocutaneous flaps. BibTex ; Full citation; Abstract. Free iliac crest. Lateral arm flap. Article rvis par les pairs. Lateral Arm Flap, This local pedicled fasciocutaneous flap is a useful flap for the elbow soft tissue coverage based on the posterior radial collateral artery (PRCA) and the septocutaneous perforators [ 24 ]. The radial recurrent fasciocutaneous flap as described by Maruyama and Takeuchi represents one of the best solutions for medium-sized defects. coverage of the elbow lateral arm flap brachio-radialis posterior interosseous flap latissimus dorsi flap antecubital flap . Careful early wound management is crucial to ensure successful outcomes following reconstruction. Request PDF | Lateral arm perforator flap as an island advancement flap for posterior elbow soft tissue reconstruction | Many flap designs for coverage of soft-tissue defects of the posterior . The lateral arm flap (LAF) is a popular flap transfer, which can be applied in many procedures. This technique can facilitate a greater distal coverage of the forearm when the pedicled LD musculocutaneous flap is rotated. Intended for healthcare professionals For large defects around the elbow. The skin overlying the lateral arm varies in thickness. It is well-suited for covering defects where a thin flap is required, especially the dorsum of the hand . The lateral arm perforator flaps for elbow soft-tissue coverage have a propeller design. antecubital flap. The results concerning defect . as a versatile free flap that could be used in many reconstructions [3]. lateral arm flap: technique indications: - coverage of anterior and posterior aspects of the elbow. Maximal superior reach? The flap can be elevated on the medial aspect of the forearm (over the flexor muscle group) or on the lateral . Many techniques have been published, mostly case reports. Topics: Ensaio clnico, Anatomia, Retalhos cirrgicos, Clinical Trial, Anatomy . The entire skin paddle can survive if enough musculocutaneous perforators are included in the proximal portion of the skin paddle design. This can reduce operative time and potentially the failure rate. Perforator Based Free Lateral Thigh Flap for Coverage of Complex Extremity Defects: A Retrospective Case Series at a Tertiary Care Hospital in an LMIC OPEN ACCESS *Correspondence: Pervaiz Mehmood Hashmi, Departments of Surgery Orthopedic, Hand & Reconstructive Microvascular Surgery, Aga Khan University Hospital, Karachi, Pakistan, Tel: +92-3452105652; Fax: +92-21 34934294; E-mail: Pervaiz . Abdominal Bipedicle. 1 Alternative flaps for defect coverage of the elbow. Various muscle, fasciocutaneous, and cutaneous flaps have been described as coverage options for posterior elbow wounds. Abdominohypogastric. The most appropriate choice is 4 - reverse pedicled lateral arm flap. Flap sizes ranged from 3 4 to 42 16 cm2. * Their orthograde axial vascular pedicle allows the widest possible arc of rotation and present relatively little risk of circulatory embarrassment. We used it successfully in five clinical cases. A case is presented in which the flap was used in a reverse flow fashion to cover an 8 X 11 cm acute cubital defect present after soft tissue release. Functionally, these flaps allowed for the development of an average arc of motion of 20 to 114 . In two cases, both grafts and local flaps were combined to reconstruct the elbow after excision of the scar tissue. The lateral arm flap [19, 20, 25-27] is sometimes limited by its short pedicle and the scapular flap requires a change of position during the operation, hindering a two-team approach. The radial recurrent artery flap is a reliable solution for elbow coverage in the context of elbow exposure in major burns, especially in the absence of other local or regional flap options. Flaps were used when the raw area was deep, and the neurovascular bundle, tendons, or bone were exposed. The radial forearm flap possesses a flexible arc of rotation, reliable vascularity, and possible sensory innervation. . CONFLICT OF INTEREST STATEMENT None declared. The vessel is 0.75-1.5 mm in diameter, and the pedicle is 8 cm in length. Anterolateral thigh (ALT) free flap. A free lateral arm flap from the contra-lateral arm was successfully used in conjunction with a pedicled reversed lateral arm flap from the injured limb. Some flaps used for elbow coverage are orthograde antecubital fasciocutaneous flap, radial forearm, ulnar forearm, and posterior interosseous flaps and retrograde medial and lateral arm flaps.
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