Reconstruction of Composite Tissue Defect of the Hand using the Osteofasciocutaneous Lateral Arm Free Flap

ABSTRACT

There are severe soft tissue defects associated with intercalary segmental or distal loss of bone in the crushing injury of the hand by high-energy machine such as presser, electrical saw, and agricultural machine. Bone grafting to restore the skeletal scaffold is essential for reconstruction of the soft tissue and preservation of the digit function. However, non-vascularized free bone grafts are not desirable, because recipient sites often have a poorly vascularized bed. We described 12 cases, which were reconstructed by the lateral arm osteofasciocutaneous or osteofascial free flap from 1997 to 2001. The bone was harvested from the distal humeral bone as an osteofasciocutaneous lateral arm flap that has constant osseous branches from the main pedicle of the posterior radial collateral artery along the lateral intermuscular septum. Lateral arm osteofasciocutaneous flap is able to provide well vascularized bone and soft tissue for hand reconstruction. All flaps survived and had acceptable shape and function without bone resorption. We consider that lateral arm osteofasciocutaneous flap is a useful method for reconstruction of the composite tissue defect containing the bone in one-stage operation of the hand.