The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases.

A study of the authors' experience with 210 free lateral arm flaps used to repair head and neck oncological defects over an 8-year period. Patients' ages ranged from 4 to 83 years (average: 49.7 years). One hundred and forty-one were male and 66 female. Three patients received two consecutive flaps each. They were used to reconstruct: the tongue, 53 cases; retromolar trigone, 42 cases; soft/hard palate, 34 cases; skin/facial contour, 19 cases; hypopharynx, 17 cases; buccal mucosa, 12 cases; lips, five cases. Flap cutaneous dimensions ranged from 4 x 2 cm to 17 x 8 cm. Flap was composed of: skin and fascia, 18 cases; sensate (neurovascular) skin, six cases; subcutaneous fat tissue, five cases; skin and vascularised nerve graft, three cases, skin and partial triceps muscle, three cases. Nerve coaptations were performed for all lip reconstructions. All flaps survived except for nine (success rate: 95.2%). Severe postoperative clinical complications preceded flap failure and death in two cases. All but six donor sites were closed primarily. Complications related to the donor site were: paresthesia of the forearm, 210 cases; dog ear, 16 cases; hypertropic scar, 14 cases; weakness, nine cases; haematoma, five cases; seroma, three cases; dehiscence, one case. Radial nerve injury was not observed in this series. The lateral arm flap can be considered safe and versatile for most soft tissue head and neck microsurgical reconstructions. The possibility of sensory recovery through neural anastomoses and low donor site morbidity enhances its efficiency.

Intraneural hematoma with extrinsic compression: experimental study in rats and therapeutic options.

Intraneural hematoma can result in the median nerve in the carpal tunnel after trauma or coagulation disorders. The decision for expectant management or decompressive surgical techniques is still controversial. Fifty male Wistar rats were divided into five groups. The sciatic nerve was wrapped around with a silastic device in four groups. In group A, the sciatic nerve was just wrapped by the silastic tube. In group B, an intraneural injection of autologous blood was added. In group C, after the hematoma creation, the silastic device was removed and a longitudinal epineurotomy was performed. In group D, the silastic device was removed after the hematoma, but the nerve was not opened. In group E (sham-operated), the sciatic nerve was exposed without hematoma or compression. Nerve function recovery was assessed periodically over 61 days using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI). Group A (extrinsic compression) presented initial SFI of -26.29 +/- 2.89, with return to baseline values on the fifth postoperative day. Group B (hematoma and extrinsic compression) exhibited the poorest function (SFI of -85.23 +/- 3.51) after surgery and recovery in 23 days. Group C (liberation of silastic and hematoma drainage through epineurotomy) and group D (only removal of the silastic tube) presented similar initial SFI values of -32.78 +/- 7.45 and -45.13 +/- 6.84, respectively. In both the groups, the SFI values returned to baseline level on fifth postoperative day. The statistical analysis of SFI identified a significant difference (P < .0001) between the expectant management (group B) and the descompressive surgery approach (groups C and D) by 1st to 19th postoperative day. The number of degenerative fibers and density of degenerative fibers were statistically significantly longer in group B when compared with the other groups. There was no statistical difference between the other groups when these parameters were analyzed. Thus, immediate decompressive procedures of the intraneural hematoma provide a faster functional recovery and reduce the damage to the axon fibers.