Lateral Arm Free Flap Harvest - Standard (Feat. Dr. Pet)
SURGICAL PROCEDURE
Lateral Arm Free Flap Harvest
Authors: Pet, MA1, Yee A1
Published: September 4, 2020
Author Information
1 - Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
Standard Edition ()
ABSTRACT
The lateral arm free flap is a fasciocutaneous flap, which can also be modified to include muscle and/or bone. This flap is based upon the posterior radial collateral vessels within the lateral intermuscular septum between the triceps posteriorly, and the brachioradialis and brachialis anteriorly. The axis of the flap is marked on a line between the deltoid insertion and the lateral epicondyle. In this case, a traditional lateral arm flap is harvested, but it should be noted that extension of the cutaneous paddle across the lateral epicondyle and onto the proximal third of the forearm is reliable, and often useful. The patient in this video presented with a recurrent sarcoma in the right forearm with a previously radiated bed. After re-resection, there was a 6 x 12 cm wound overlying the ulnar border with exposed ulnar neurovascular bundle and ulna. This instructional video details the harvest of a lateral arm fasciocutaneous free flap for coverage of this defect.
KEYWORDS
free flap, posterior radial collateral artery, lateral intermuscular septum, radial nerve, lateral arm flap
POSITION
Supine.
INCISION
The axis of the flap is marked along the line between the deltoid insertion and the lateral epicondyle on the posterolateral aspect of the arm. The presence of perforating vessels along this axis is confirmed using a handheld doppler, and an elliptical flap is marked along this axis to incorporate the perforating vessels.
TABLE OF CONTENTS (Standard)
00:00 Introduction
00:10 Case Presentation
00:37 Orientation
00:50 Surface Markings for Incision
02:05 Incision
02:31 Posterior Dissection of the Flap
03:04 Exposure and Identification of Tendon of the Triceps Brachii
03:14 Identifying the Longitudinal Perforator Vessel and Plane of Dissection
03:41 Dissecting the Flap from the Triceps Brachii
04:55 Following the Longitudinal Perforator Vessel Proximally
05:17 Identifying the Radial Collateral Vessels Supplying the Flap
05:22 Resecting the Triceps Muscle from the Lateral Intermuscular Septum
05:41 Extending the Incision Proximally for Additional Exposure
06:21 Dividing the Lateral Intermuscular Septum
06:38 Identifying the Posterior Brachial Cutaneous Nerve
07:27 Further Release of the Triceps Muscle from the Flap
08:54 Critical View of the Radial Nerve and Radial Collateral Artery and Vessels
09:08 Identifying the Vascular Branch to the Triceps
09:43 Anterior Dissection of the Flap
10:06 Identifying of the Brachioradialis an Brachialis
11:29 Elevating the Flap from Brachioradialis an Brachialis
12:29 Identifying the Longitudinal Perforator Vessel
13:23 Exposure the Humeral Attachment Posteriorly
14:04 Incising the Humeral Attachment
14:27 Elevating the Flap Distally from the Humerus
15:24 Dividing the Anterior Branch of the Radial Collateral Vessels from the Radial Nerve
16:11 Dividing the Vascular Branch to the Triceps
16:26 Further Exposure of the Vascular Pedicle to the Flap
16:37 Dividing the Posterior Brachial Cutaneous Nerve
17:04 Identifying the Venous and Arterial Component of the Pedicle
17:42 Take Down of Tourniquet and Checking Perfusion of Flap
18:12 Dividing an Accessory Pedicle and Checking Perfusion of Flap
18:34 Clipping and Dividing the Radial Colleterial Artery and Vein to Mobilize the Flap
18:55 Post-Operative Results
19:11 Credits
1 view
502
45
4 weeks ago 00:18:26 6
Dua Lipa: Tiny Desk Concert
4 weeks ago 00:01:32 1
Джо Байден в СССР 31 августа 1979 / Joe Biden in USSR (1979)
4 weeks ago 00:03:00 1
Lil Hardin Armstrong - Doin’ The Suzie Q - 1936
4 weeks ago 01:51:22 1
China vs. United States | Cold War | Nuclear Threat | Investigative Journalism
4 weeks ago 00:05:28 1
Comedy for ELT - Pronunciation Problems
1 month ago 00:03:23 1
Karussell - Als ich fortging 1987
1 month ago 00:08:46 2
LVIV on FIRE: British & Canadian Military Instructors Took Off in The AIR Along With Training Center
1 month ago 00:02:51 1
Bruce Willis clutches onto ex wife Demi Moore in new rare pic in birthday tribute shared by actress
1 month ago 00:06:36 1
Хотите иметь крепкое тело? Мышцы ни при чем! Все дело в фасциях! 👀
1 month ago 00:30:53 1
Fall Challenge Day 9: 30-Minute Full Body Supersets
1 month ago 00:03:51 4
FINALLY! Russia cleared Olgovka revealed streets filled with Ukrainian victims and equipment
1 month ago 00:07:40 1
Woman Dies 4 days after getting COVID Vaccine | Post Vaccine Deaths
1 month ago 00:08:10 1
30 PUSH UP VARIATIONS (BEGINNER TO ADVANCED)
1 month ago 00:03:00 3
Piles of American vehicles turned into scrap metal at Russian liberated Krasny Yar
1 month ago 00:01:32 1
Джо Байден в СССР 31 августа 1979 (СУБТИТРЫ) / Joe Biden in USSR (1979)
1 month ago 00:00:00 1
6 Super Easy Exercises to Get Bigger Shoulders Fastest
1 month ago 00:25:17 1
25-Minute SUPERSET Leg Workout with Dumbbells (Leg Burnout)
1 month ago 00:02:40 1
EARTHBURNER - Slaves To The Screen (Official Visualizer)
1 month ago 00:08:03 6
Cyberpunk 2077 Pathtracing | Heavily Modded
1 month ago 00:00:00 1
Ricardo Villalobos | Cocoon Club Amnesia Ibiza () Classic Mix
1 month ago 00:03:16 1
Ella Fitzgerald - All The Things You Are (with lyrics)