title: Perforator Mapping and Optimizing Design of the Lateral Arm Flap: Anatomy Revisited and Clinical Experience.
abstract: BACKGROUND
  The lateral arm flap remains an underused flap, especially as a free flap. In this article, the authors describe the perforator anatomy to optimize flap design and harvest.
  
  
  METHODS
  Perforator locations were mapped in 12 cadavers (24 arms), and a retrospective review was conducted of 51 patients undergoing lateral arm flap surgery.
  
  
  RESULTS
  One to three reliable perforators supply the lateral arm flap. Based on cadaveric dissections, from the deltoid insertion, the A, B, and C perforators were located at 7.2 ± 1.0 cm, 9.9 ± 1.2 cm, and 11.8 ± 0.8 cm, which was 0.44, 0.61, and 0.72 of the distance from the deltoid insertion, respectively. The average pedicle length was 7.0 ± 1.1 cm. The cadavers were entirely symmetric in the number and location of the perforators between the right and left arms. All 51 patients (24 male and 27 female patients) had at least one perforator with an average pedicle length of 7.0 ± 1.3 cm, an average arterial diameter of 1.7 ± 0.3 mm, and a vein diameter of 2.5 ± 0.5 mm. All but one flap was performed as a free flap for head and neck reconstruction, with one pedicled flap for shoulder reconstruction. The average flap size was 72.2 ± 37.1 cm (range, 21 to 165 cm). The nondominant arm was used for all free flaps. There were no total or partial flap losses. Twenty-eight patients reported donor-site numbness, with one infection, one hematoma, and one wound dehiscence.
  
  
  CONCLUSIONS
  The lateral arm flap can be harvested reliably based on well-defined perforators and anatomical landmarks with minimal donor-site morbidity and should be included among the techniques used by reconstructive microsurgeons.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Amir
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Nazareth
authors.initials: N
authors.lastname: Papazian
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Abdo
authors.initials: A
authors.lastname: Jurgus
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Suami
authors.affiliation: Houston, Texas; and Beirut, Lebanon.|From the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic Surgery and Department of Anatomy, Cell Biology & Physiology, American University of Beirut.
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
mesh_terms: D059925:Anatomic Landmarks; D001132:Arm / Q000601:surgery; D002102:Cadaver; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D061525:Perforator Flap; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013848:Thigh / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods*