Eur J Plast Surg (2004) 27:81–85
V. L. Moser · A. Gohritz · J. van Schoonhoven ·
U. Lanz · H. Krimmer
The free lateral arm flap in reconstructive hand surgery
Received: 5 November 2003 / Accepted: 12 January 2003 / Published online: 23 March 2004
Abstract Microsurgical tissue transplantation has pro-
vided a great advance in reconstructive surgery, especial-
ly regarding upper limb defects. Compared to conven-
tional pedicled flaps, mobilisation can occur earlier,
hospital stay is shorter and no additional interventions for
pedicle detachment and flap inset are needed. The later-
al arm flap is an exceptionally versatile free flap with
straightforward dissection and low donor site morbidity.
End-to-side anastomosis preserves blood flow through the
main arteries to the hand and reduces the risk of vascular
compromise of the hand, which is especially important
in case of severe hand injuries. Sixteen patients who
underwent hand reconstruction using the lateral arm free
flap are reviewed. All arterial anastomoses were con-
ducted in end-to-side-technique either to the radial or the
ulnar artery. There was no total- or partial-flap failure and
only one revisional procedure due to a haematoma under
the anastomosis. Eight flaps required secondary defatting,
combined with removal of osteosynthesis material or
tenolysis. From our point of view the free lateral arm flap
is a very reliable and versatile method to resurface small
and medium sized hand defects.
Keywords Lateral arm flap · Hand defect · Free flap ·
The lateral arm flap was introduced by Song et al. in 1982
 and first popularized by Katasaros et al. in 1984 .
Due to a constant vascular pedicle and low donor side
morbidity this flap has become recognised as one of the
most popular sources for covering skin defects when soft,
thin and pliable tissue is needed, above all in head and
neck and extremity reconstruction [1, 2, 3, 4, 5, 6, 7, 9, 12,
13, 17]. The lateral arm flap is similar to the formerly
very popular radial forearm flap  but offers the
distinct advantage that its nutrient artery, the posterior
radial collateral artery, is not essential to the vascularity
of the hand and the donor defect can be mostly closed
directly with a linear scar.
In cases of severe crushed hand injuries, early mobil-
isation and intensive physical therapy is important to
achieve functional rehabilitation with good clinical re-
sults. This can be seen as an important advantage over
distant pedicled flaps such as the groin flap  which
require lengthy immobilisation of the hand and adjacent
joints. Furthermore free flaps bring additional blood sup-
ply to the reconstructed area, in contrast to distant
pedicled flaps which may become parasitic on the re-
cipient side after division of the pedicle. Regarding the
great variety of free flaps currently used in hand injury,
fascial flaps offer the additional bonus of providing good
gliding tissue and thus minimizing scarring of tendons
involved in the injury.
Alternative fascial flaps are the serratus anterior-,
dorsalis pedis and temporalis flap. We report our expe-
rience with the lateral arm flap, emphasizing the versa-
tility and wide application of this method.
Patients and methods
Sixteen patients underwent a free fasciocutaneous lateral arm flap
between March 1998 and September 2003. The patients were 12
male and four female, with an average of 43 years (range: 18–76).
Operations were indicated for severe hand trauma in ten cases, four
after skin necrosis due to extravasion of cytostatics or extended
hand infection, one after tumour ablation and one for improvement
of the first web space due to congenital hand deformity.
All arterial anastomoses were performed in end-to-side tech-
nique either to the radial or the ulnar artery, the venous anasto-
moses were conducted in an end-to-end technique. In one case end-
to-end neurorrhaphy between the lower cutaneous posterior bra-
chial nerve and a branch of the superficial radial nerve was done.
During the follow-up period ranging from 3 months to 5 years
and 2 months (average: 17 months) one patient died because of a
metastatic osteosarcoma and three patients were lost for follow up.
V. L. Moser · A. Gohritz · J. van Schoonhoven · U. Lanz ·
H. Krimmer (
Bad Neustadt Hand Centre,
Salzburger Leite 1, 97616 Bad Neustadt, Germany
Tel.: +49-9771-62801, Fax: +49-9771-659201