Lateral Arm Free Flap with Preservation of the Posterior Antebrachial Cutaneous Nerve

초록

Purpose : The lateral arm free flap has been used widely in reconstructive surgery. However, sensory loss at the posterior forearm is occurred due to sacrifice of the posterior antebrachial cutaneous nerve (PABCN) during flap harvest. In this study, the author introduce the PABCN-sparing lateral arm free flap with evaluation of outcomes in terms of technical feasibility and effectiveness. Methods : A single institutional retrospective review identified 19 patients with tissue defects who underwent reconstruction using the lateral arm free flap between September 2005 and February 2012. As the lateral intermuscular septum was dissected, the septal branch (SB) of the PABCN was identified and included in the flap itself and the main trunk of the PABCN was preserved. The SB was anastomosed for sensory recovery of recipients. Results : All flaps survived without partial necrosis. Three patients exhibited transient sensory loss in the posterior area of the forearm, and 2 of these patients recovered sensation within the first month after the operation. In the case of a patient who required division and neurorrhaphy of the PABCN, Tinel sign was present at 2 weeks after neurorrhaphy, and the sensation in the posterior forearm had recovered after 16 months. Conclusion : In this study, the author describe for the first time about the SB of the PABCN and sensation to the flap may be provided by the SN of the PABCN. Also, this study demonstrated that the PABCN can be saved during harvest of the lateral arm free flap.