Revisiting the Lateral Arm Free Flap for oral defects: a case series on flap viability and primary donor site closure
Abstract
The reconstruction of complex oral cavity defects following oncologic resection requires versatile soft tissue flaps that restore tissue volume while minimizing donor-site morbidity. While the Radial Forearm Free Flap (RFFF) is a standard option, it is associated with conspicuous donor site morbidity [1]. This study evaluates the efficacy, clinical reliability, and donor site morbidity of the Lateral Arm Free Flap (LAF) in head and neck reconstruction. A prospective case series was conducted from June 2022 to June 2024 at the National Cancer Institute (Cairo University) and Assiut University Hospitals. Twelve patients with medium-sized soft-tissue defects (tongue, cheek, floor of the mouth) underwent reconstruction with LAF. Parameters assessed included flap viability, operative characteristics, donor site closure (primary vs. secondary), and postoperative complications. The study included 12 patients (7 females, 5 males) with a mean age of 50.3 years. The majority of defects were in the tongue (9 of 12 patients). Complete flap survival was achieved in 11 of 12 patients, while one patient experienced total flap loss secondary to venous congestion. Partial flap necrosis occurred in two patients and healed with conservative management, and the mean flap harvesting time was 47.5 min. Primary closure of the donor site was achieved in 10 patients. Complications included hypertrophic scarring in seven patients. Furthermore, five patients developed sensory deficits (numbness/hypesthesia) due to division of the posterior cutaneous nerve of the forearm (PCNF), with no patients developing radial nerve injury or wrist weakness. The Lateral Arm Free Flap is a reliable alternative to the RFFF for small- to medium-sized oral defects. It offers the distinct advantage of primary donor site closure and adequate tissue bulk for glossectomy defects, though variable vessel caliber remains a technical consideration [2, 3].